Get that Beauty Sleep
Coping with Chronic Disease
Stretch That Muscle
Healthy Recipe Fish Soup Bee Hoon
A newsletter fo r p atients • Jun - Jul 2 0 0 8
Get that Beauty Sleep
Many people lose their beauty sleep because of
insomnia, which is a condition characterised by a
persistent difficulty in falling or staying asleep and
which is typically followed by functional impairment
when awake. People who suffer from insomnia may
encounter daytime tiredness, depression, poor
concentration and irritability that affect their daily
function. Insomnia affects one third of the adult
population and is a long-term problem for some.
There are three clear types of insomnia:
Transient insomnia may last from days to weeks.
It can be caused by another medical disorder,
changes in the sleeping environment, timing of sleep
or stress. This type of insomnia occurs from time
Acute insomnia is the inability to consistently sleep
well for a period of three weeks to six months.
Chronic insomnia lasts from months to years. It
can be caused by another disorder or it can be a
primary disorder. People with chronic insomnia often
show a paradoxical increase in alertness. It is
estimated that people who suffer from chronic
insomnia are twice as likely to experience road traffic
What are the causes of insomnia?
Short-term insomnia can be caused by changes in work
shift, jet lag, stress, noise disturbance, illness or surgery,
or a change in sleep environment. People with chronic
insomnia may be suffering from psychiatric illnesses such
as depression or anxiety. They may also be suffering from
restless legs syndrome or sleep apnoea (characterised
by pauses in breathing during sleep) or may be consuming
drugs for respiratory diseases, such as Theophylline.
Chronic insufficient sleep may also be caused by lifestyle
factors such as holding two jobs at one time or consuming
caffeine at night.
How you can sleep better
Besides relying on medication, you can use these techniques
to help you sleep better:
1. Establish a regular sleep schedule, even on weekends.
Go to bed at the same time each night and get up at
the same time each day.
2. If you are not asleep within 20 minutes after going to
bed, get up and read or engage in a non-strenuous
activity until you feel sleepy. Do not watch television
or read while in bed.
3. Make the bedroom comfortable. Block out noises, keep
the room dark and ensure a comfortable room
4. Wind down and relax when bedtime is near. Practise
muscle relaxation therapy or listen to relaxing music.
Do not exercise vigorously or engage in over-stimulating
activities just before bedtime.
5. Do not nap during the day, especially in the late
afternoon. This will disrupt your biological clock.
6. Do not consume caffeine after lunch or use alcohol to
There are also special therapies for improving sleep,
such as sleep restriction therapy, stimulus control
and cognitive behavioural therapy. You will need
expert guidance for these treatments.
You should consult your doctor if your insomnia
persists. In cases where behavioural measures do
not help, drugs such as Benzodiazepine can be
prescribed to treat insomnia.
By Dr Raymond Ng, Family Physician, Toa Payoh Polyclinic
MICA (P) 264/01/2007
Eczema is a term that broadly describes several
types of inflammation of the skin. The most common
type of eczema is ‘atopic dermatitis’, which is a noncontagious allergic skin reaction. There is usually a
hereditary component. Affected individuals usually
have a inherited tendency to develop other allergic
conditions such as asthma and sensitive nose.
Symptoms of Eczema
Eczema often causes itchiness and when you scratch
it, the skin becomes red and inflamed. It can occur
in babies, children and adults.
Atopic dermatitis during infancy is called ‘infantile
eczema’, where itchy patches are often seen
developing on the baby’s scalp and face, especially
on the cheeks. When atopic dermatitis develops in
an infant or a young child, it tends to disappear over
time. For some children, the condition completely
resolves by the age of two. Although atopic dermatitis
can be a lifelong condition, it usually becomes less
severe with age. During the teenage and young
adult years, the itchy patches often develop on the
elbows and knees. However, they can also appear
on other parts of the body such as around the eyes
and on the eyelids.
How to manage eczema?
Although eczema cannot be cured, it can be managed by
getting to know the triggering factors and avoiding them.
Common triggers of eczema include soaps, detergents,
jewelry, clothing, perspiration, certain food, and stress.
Follow these simple precautions:
• Get to know the food that may trigger an outbreak and
• Limit your contact with things that may irritate your
skin, such as household cleansers, detergents and
solvents. If you have eczema of your hands, dry your
hands completely after wash.
• Wear gloves to protect your skin. You may wear cotton
gloves under rubber gloves to soak up the sweat on
• Wear clothes made of cotton as wool and some synthetic
fabrics can irritate your skin.
How to identify eczema?
An eczema rash is usually patchy and starts out as
a flaky or scaly dry skin on top of reddened, inflamed
skin. When scratched, the skin may ooze and become
crusty. This is especially seen in young children. For
adults, the patches are more likely to be brownish,
scaly and thick.
Some people may develop red or clear fluid-filled
bumps that look "bubbly". When scratched, they
may add wetness to the overall appearance. Painful
cracks can also develop over time.
• Bathe with mild soap. Keep the water temperature cool
or warm but not hot. After bath, pat your skin dry with
a soft towel and apply moisturiser to reduce itchiness.
• Apply moisturiser to your skin on a daily basis as this
keeps your skin soft and prevents cracks. A plain
moisturiser without fragrance is best.
• Use the medicine your doctor has prescribed for you
right after bath. The medicine used to treat eczema is
usually a topical steroid cream.
• Avoid scratching or rubbing the itchy area as scratching
can cause your skin to break and make it more prone
• Learn how to recognise and manage the stress in your
life as it can cause your eczema to flare up.
By Dr Lim Pui San, Senior Family Doctor and Deputy Head, Toa Payoh Polyclinic
Ekzema ialah satu istilah yang secara am
menerangkan beberapa jenis inflamasi pada kulit.
Jenis ekzema yang paling biasa terjadi ialah
“dermatitis atopik”, suatu gerak balas alahan kulit
yang tidak berjangkit. Ia biasanya berusul daripada
keturunan. Individu yang mempunyai keadaan ini
lazimnya juga mewarisi kecenderungan untuk
mendapat keadaan alahan lain seperti asma (lelah)
dan hidung yang sensitif.
Ekzema selalu menyebabkan rasa gatal dan bila
digaru, kulit akan menjadi merah dan bengkak. Ia
boleh terjadi kepada bayi, kanak-kanak dan orang
Dermatitis atopik di kalangan bayi dipanggil ‘ekzema
infantil’, di mana tompok-tompok yang gatal biasanya
terdapat di kulit kepala dan muka, terutamanya di
bahagian pipi. Apabila bayi atau kanak-kanak
menghidap dermatitis atopik, lambat laun keadaan
ini akan hilang. Bagi sesetengah kanak-kanak,
keadaan ini akan terus hilang apabila dia menjangkau
umur dua tahun. Walaupun dermatitis atopik boleh
dihidap seumur hidup, ia lazimnya akan kurang
serius bila umur semakin meningkat. Semasa
peringkat remaja dan awal dewasa, tompok-tompok
yang gatal itu biasanya terdapat di bahagian siku
dan lutut. Namun, ia juga boleh terjadi di bahagianbahagian lain seperti di perkelilingan mata dan di
atas kelopak mata.
Bagaimana mengenali ekzema?
Ruam ekzema lazimnya bertompok-tompok dan
bermula sebagai kulit kering yang berkepingan atau
bersisik di atas kulit yang telah mengalami inflamasi
(iaitu pembengkakan) dan kemerahan. Bila digaru,
kulit mungkin terkelupas dan menjadi keruping.
Keadaan ini didapati terutamanya di kalangan kanakkanak kecil. Bagi orang dewasa, tompok-tompok ini
lebih kerapnya akan kelihatan berwarna coklat,
bersisik dan tebal.
Sesetengah orang mungkin akan ada benjol-benjol
kemerahan atau mengandungi cecair jernih yang
kelihatan seperti buih. Bila digaru, ia mungkin benjolbenjol menambahkan kebasahan pada kulit. Lamakelamaan, kerekahan kulit yang berasa sakit pula
Bagaimana anda boleh menguruskan
Walaupun ekzema tidak boleh diubati, ia boleh diuruskan
dengan mengenalpasti faktor-faktor penyebab dan cara
mengelakkannya. Penyebab-penyebab yang biasa
termasuk sabun, bahan pembersih, barang kemas, pakaian,
peluh, sesetengah jenis makanan, dan tekanan.
Ikutilah langkah berjaga-jaga yang mudah ini:
• Mengetahui makanan yang mungkin menjadi penyebab
alahan dan elakkan makanan itu.
• Hadkan sentuhan dengan benda-benda yang mungkin
boleh menyebabkan kerengsaan kulit anda, seperti
bahan pembersih rumah, bahan pencuci dan bahan
pelarut. Jika anda mempunyai ekzema di bahagian
tangan, keringkan tangan anda sepenuhnya selepas
• Gunakan sarung tangan untuk memelihara tangan
anda. Anda boleh memakai sarung tangan berjenis
kapas yang bawahnya berjenis getah untuk meresap
peluh di tangan anda.
• Pakai baju yang diperbuat daripada kapas kerana bulu
haiwan dan sesetengah fabrik sintetik boleh
menyebabkan kerengsaan kulit.
• Gunakan sabun yang lembut untuk mandi. Suhu air
seharusnya dingin atau suam dan bukan panas. Selepas
mandi, keringkan kulit anda dengan sehelai tuala lembut
dan sapukan pelembap untuk mengurangkan rasa gatal.
• Gunakan pelembap untuk kulit anda setiap hari kerana
ia akan menjadikan kulit anda lembut dan mencegah
kerekahan kulit. Pelembap tanpa wangian adalah yang
terbaik untuk digunakan.
• Gunakan ubat yang telah dipreskripsikan oleh doktor
anda sebaik sahaja selepas anda mandi. Ubat untuk
merawat ekzema biasanya adalah sejenis krim steroid
• Elak daripada menggaru atau menggeser kawasan yang
gatal kerana menggaru akan menyebabkan kulit anda
pecah dan memudahkan jangkitan padanya.
• Belajar untuk mengenali dan menguruskan tekanan
dalam hidup anda kerana tekanan boleh merangsangkan
Coping with Chronic Disease
Caring for your emotional well-being
Emotional well-being has been found to affect a
person’s physical health. Thus by maintaining healthy
emotions, it helps you to manage your conditions
1) Accept your condition
Acceptance of a condition does not mean ‘resigning
to fate’ and giving up the fight. It simply means
freeing yourself from the stress and diverting
your energies towards working on recovery and
2) Learn from success stories
Join support groups and learn from the success
stories of other patients who have adapted well.
This will help to motivate you towards the road
“56-year-old Mdm Tham had been a regular smoker
who enjoyed travelling and going out with her family
members and friends. But ever since she suffered
a stroke one year ago, she finds her life confined
to the four walls of her 4-room HDB flat with the
help of a walking aid. She has also quit smoking
When Mdm Tham first developed stroke, she had
suffered paralysis on the left side of her body. Her
daily needs had to be taken care of by a caregiver.
Mdm Tham had sunk into depression and felt that
she was a burden to her children. She constantly
went into low mood and would often cry to herself.
Thankfully, Mdm Tham’s children were caring and
encouraging as they supported her on her road to
recovery. She attended therapy sessions and soon
regained basic skills like speaking and movement
of her left arm and leg. However, due to her condition,
Mdm Tham had to give up many activities she
enjoyed. This knowledge often brought back bouts
Mdm Tham represents just one of the many patients
suffering from chronic illnesses and the tremendous
lifestyle changes they face. Many of these patients
find it hard to accept their conditions as it means
that they have “lost the battle” and their lives have
been eroded. They are also fearful of the uncertainty
their illness brings forth. The stress may haunt the
patients’ minds and gradually deplete them of the
emotional energy needed to help them move forward.
3) Maintain quality relationships
Do not wall yourself up. Continue to maintain
quality relationships with your family members
and friends. Regularly talk to them or participate
in activities like family gatherings. This provides
you with the emotional support necessary to
keep you going.
4) Find ways to enjoy life
It doesn’t mean that you have to give up on the
enjoyments of life once you are hit by a chronic
illness. Work with your caregivers to find ways
to get around the inconveniences caused by the
illness and continue to engage in activities you
5) Maintain daily routine
Try to maintain a daily routine of work, errands,
household chores, and hobbies as much as
possible. This provides a feeling of stability while
coping with the disruptions and uncertainties that
6) Consult your physician
Consult your physician and counsellor to help
develop appropriate coping strategies.
Suffering from chronic illnesses does not mean life
comes to a standstill. If you maintain healthy
emotions and diligently work towards recovery, it
is possible to continue living a quality lifestyle.
References from American Psychological Association and Mind
By Henry Lew, Psychologist, NHG Polyclinics
Rhinitis is an inflammation of the inner lining of
the nose, which causes sneezing and produces clear
nasal discharge or blockage. When rhinitis occurs
due to an allergic response to airborne particles
called “allergens”, it is known as Allergic Rhinitis
These allergens may come into contact with a
person’s eyes, nose and lungs and certain cells in
these areas may overreact to release substances,
like histamine, which cause the above symptoms.
This disorder tends to run in families and is often
seen in people with sensitive skin and asthma.
There are two main types of AR:
Seasonal and Perennial.
Pollen in spring
Itchy eyes, nose
House dust mite,
guest in human
Cat’s fur, tiny
pieces of animals’
skin and fungal
Protecting yourself against
Allergic Rhinitis can be avoided by maintaining good
general health through diet and exercise and avoiding
chemical irritants such as smoke, cosmetics, paints
and sprays. However, avoiding the allergen may be
difficult for some as oftentimes the exact triggers
are not known.
Nevertheless, some simple steps may help:
1. Encase the mattress and pillows in ‘mite proof’
covers and wash the covers at least three times
2. Wash beddings frequently in water at temperatures
higher than 55 degree Celsius to kill the dust
3. Vacuum, damp dust or mop the floor instead of
sweeping. This is to reduce air-borne dust.
4. Minimise the number of carpets, curtains and
uncovered bookshelves in your home.
5. Do not keep furry pets, especially cats, if you are
prone to AR.
Most symptoms of AR can be readily treated.
Medication can be oral or intranasal (into the nose).
Antihistamines are taken orally and usually prescribed
as the first line of treatment. They are available in
drowsy and non-drowsy formulations, but drowsy
formulation may be more desirable at night.
Antihistamines are also available in combination
tablets with oral decongestants to help reduce
congestion or swelling. Intranasal decongestants
can only be used for a maximum of one week because
they can cause a rebound in the nasal congestion
if taken off after being used for a prolonged period.
Intranasal steroids are most effective and used for
moderate to severe AR. They are safe to use for a
prolonged period, on the advice of your doctor.
The occurrence of nasal polyps – grape-like growths
causing nasal obstruction, is higher in people with
allergic rhinitis. For such, surgery may be required.
You should consult your doctor if you develop severe
symptoms of allergies, if previously successful
treatment has become ineffective, or if your
symptoms do not respond to treatment.
By Dr Anuj Gupta, Family Doctor, Clementi Polyclinic
Stretch That Muscle
Fish Soup Bee Hoon
Stretching can do more than just increase flexibility.
It is the deliberate lengthening of muscles in order
to increase muscle flexibility and joint range of
motion. Stretching activities are an important part
of any exercise or rehabilitation programme. They
help to warm up the body prior to an activity, thus
decreasing the risk of injury and muscle soreness.
It is essential to practise proper stretching techniques
to avoid unnecessary injury.
Stretching muscles when they are cold increases
the risk of pulled muscles. Warm-up by walking
while gently pumping your arms, or do a favourite
exercise at low intensity for five minutes.
Stretch your muscles
It takes time to lengthen tissues safely. Hold your
stretches for at least 30 seconds and up to 60
seconds for a really tight muscle or problematic
area. That can seem like a long time so wear a watch
or keep an eye on the clock to make sure you are
holding your stretches long enough. For most of
your muscle groups, if you hold the stretches for at
least 30 seconds, you will need to do each stretch
Do not bounce
Bouncing as you stretch can cause small tears (micro
tears) in the muscle, which leave scar tissue as the
muscle heals. The scar tissue tightens the muscle
even further, making you less flexible — and more
prone to pain.
Focus on a pain-free stretch
If you feel pain as you stretch, you have gone too
far. Back off to the point where you do not feel any
pain, then hold the stretch.
200gms Mackerel, sliced
450gms bee hoon, cooked
8 slices ginger, sliced
2 pieces tofu, cut into cubes
2 stalks spring onion, cut finely
2 large red chillies
1 tsp ginger juice
1 tsp pepper
8 cups water
1. Season fish with ginger juice and pepper for 5
2. Bring water to boil and add seasoned sliced fish.
3. Add sliced ginger and tofu cubes. Lastly, add the
4. Pour hot soup and ingredients over bee hoon.
5. Garnish with freshly cut chillies and spring onions.
Relax and breathe evenly. Do not hold your breath
while you are stretching
Stretch both sides
Dr Tung Yew Cheong, Woodlands Polyclinic
Make sure your joint range of motion is as equal as
possible on each side of your body.
Ms Eleanor Toh, Corporate Communications, HQ
Stretch before and after activity
Ms Jancy Mathews, Health Promotion & Preventive Care, HQ
Ms Pauline Ang, Singapore Footcare Centre
Ms See Yen Theng, NHG Pharmacy
Perform light stretching after your warm-up, followed
by a more thorough stretching regimen after your
By Mr John Abraham, Physiotherapist, NHG Polyclinics
The information produced is for reference and educational purposes
only. As each person’s medical condition is unique, you should not
rely on the information contained in this newsletter as substitute
for personal medical attention, diagnosis or hands-on treatment. If
you are concerned about your health, please consult a healthcare
Reproduction of the articles in whole or part without permission is
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