Not just an earthly problem!

Not that sleep-deprivation is the biggest danger to astronauts in space, this article includes some interesting sleep related facts:

• Nearly half of the medications the astronauts take with them are sleep aids
• Light sensitive cells in the eye use light to regulate the hormone melatonin, which in turn regulates our sleep-wake cycles, which is something that could also be used to help astronauts keep a sleep cycle

Mistakes made due to sleep deprivation could have even greater consequences in space so this is a big issue for NASA. Makes me wonder if the loss of that $100,000 tool bag recently was in part caused by astronaut fatigue. You can track its progress here.

Black Friday

I do have to say I don't understand those who went shopping this morning before the crack of dawn to look for bargains with thousands of their closest friends, sacrificing a good sleep. Hope it was worth it :-)

Naps

Here is a great article about many sleep issues, including the issue of fragmented sleep that I have troubles with, and the positive effect of a nap. It talks about how important sleep is specifically but also how a (power) nap can help your brain function better than when you are tired. Nap length and effectiveness depends on the individual person.

I have also discovered a good power nap podcast (NapSounds) on iTunes as well though the rooster crowing at the end of the 20 minute nap recording I find a little disconcerting...

Why do we battle the signal?

Sleep is such a critical part of everyone's health and without it our quality of life deteriorates quite rapidly (as many of us kn0w). Our body does a great job of telling us when we are hungry, thirsty, or injured. It also signals quite clearly when we need to sleep.

So why do so many of us (me included some times) battle that signal, sometimes with the help of caffeine or high-caffeine products? I do understand doing that to survive the work day, or the working of different hours, if you are very tired and have no real choice BUT doing this to excess is only going to give you short term gain for long term pain. Yes, you will go for longer than you otherwise could but this is a battle you will never win and ultimately your body will be negatively impacted by this "abuse" and you will pay the price.

Don't battle the sleep signal too long - you will be sorry you did and in the long run you will be happier and much more productive if you have had your needed sleep.

Another Drug-Free Sleep Strategy

This article is a very interesting take on using self-hypnosis to get to sleep. I love the term the author used, "de-zombie-fying", to describe what someone needing a good sleep is going through and feeling like. Combined with all the other sleep assistance advice out there related to good sleep hygiene, this could be a very valuable addition to your strategies to use so you can get that sought after good night's rest.

So Far, So Good

It has now been a number of months since I went to see my doctor about my sleep issues. My problem was not falling asleep as much as staying asleep. My night seemed to be made up of lots of short naps, leaving me more and more exhausted each passing day. My outlook on life and my mood would be hard-hit by this situation and would not improve until I was so exhausted I would actually sleep through the night. However the relief would be short-lived and around I would go again with the poor night's sleep.

I have a great doctor and after discussing the situation she gave me a prescription for a medication that you don't see all the commercials on. Since then and over time I have been happy to have a much improved nightly sleep where most nights I may only wake up once or maybe twice (vs many more in the past).

Much has been written about being very cautious about using medication for this type of issue, and rightly so. However I can report no noticeable side effects and a better sleep experience.

My advice would be to heed the warnings about the use of medication, especially when it comes to short and long-term side effects as well as potential addiction (my prescription is not known for having addiction problems but time will tell). If you can solve your sleep problems with better sleep hygiene then GREAT!!!! BUT do not eliminate out of hand the potential for the right medication to improve your quality of life if that is the solution you require. Take full advantage of sleep clinics and your doctor to help you. If you have any doubt about the importance of sleep and the dangers of not getting the sleep you need, a quick search on the internet on the topic should cure you of that fairly quickly :-)

The Dangers of Sleep Apnea

Some recent headlines on sleep apnea:

Sleep Apnea May Be Deadly

Sleep apnea can raise risk of death

Sleep Apnea Linked To Increased Risk Of Death

Sleep-disordered breathing shown to be deadly

Mask provides good night's rest and promise of long-term relief for those suffering from sleep apnea

If you have sleep apnea or suspect you might have sleep apnea, you need to get it treated as soon as possible as you can see from the above headlines!! 'Nuff said.

Five Myths About Sleep

This article from Newsweek outlines 5 myths about sleep and has an interesting comment about what perhaps is our natural sleep pattern (see (Myth 1)):

(Myth 1) Humans need 8 hours sleep a night; the reality is that different cultures sleep different ways and apparently Western Europeans used to break their sleep in to a "first sleep" of 4 hours, then got up for a bit, and went back for a "second" sleep. It is noted that this in fact may be better suited to our sleep needs and natural patterns.

(Myth 2) Sleep isn't just a bodily function; the reality is that sleep is one of our systems, like we have a nervous system, and is weaker or stronger depending on the person. Also wears out and gets fragile with age (and that's not good news!!!)

(Myth 3) Animals don't have sleep problems; the article states that this is not true but there is not much support for this one so I am skeptical.

(Myth 4) Falling asleep is a gradual process; the reality is that it is more of a switch but those with sleep disorders don't have a properly functioning one. I found this interesting as I don't usually have problems getting to sleep as staying asleep is my problem (and that I have a prescription to help me with)

(Myth 5) Sleeping less burns more calories; the reality is that as you get more tired your natural appetite depressants are decreased and you become more not less hungry.

One size does NOT fit all!

As with so many other aspects of our health, men and women have many similar but also many different factors to consider. This article is a great example of this as it relates to menopause and sleep whereas women find it more difficult to get to and stay asleep during that change in their life. I can not directly relate to this as I will never go through menopause myself (and I am not touching the issue of male menopause! :-) ) but I do know the affects of lack of sleep and, as I have done in many past posts, strongly recommend those so affected consult their physician vs having a lack of sleep negatively affect their life.

Living Dangerously

The importance of getting a good sleep (and getting help if you're not!!!) is also demonstrated by this very short piece. Lack of sleep leads to poor choices as we who have problems with getting a good sleep already know. I try and steer away from critical decisions when I am know I am exhausted, for example. Beware of your less than normal caution and reasoning when you are tired and conduct yourself accordingly and you should be okay.

Another reason to exercise!!!

Yes, another reason to exercise is noted here. Not only is exercise important to your health for so many reasons, this article from Science Daily notes a study from a university in Brazil that is "...the first to look at the importance of using physical exercise to treat insomnia, and may contribute to increased quality of life in people with one of the most important kind of sleep disorders around the world"

The study explored the effects of moderate aerobic, heavy aerobic and moderate strength exercise on sleep. Four groups of people with primary chronic insomnia, one for each type of exercise and a control group, were run through their paces (so to speak :-) ).

The results of all the exercise groups were:

• reduction in sleep onset latency of 54%
• reduction in wake time of 36%
• increase in total sleep time of 21%
• increase in sleep efficiency of 18%

However the best results were after moderate aeroboc exercise:

• reduction of sleep onset latency of 40%
• increase in total sleep time of 37%
• and, a reduction of the anxiety state of the partipants in this group of 7%!

That is amazing!!! I suspect most of us already had the feeling we had a better sleep after a good work out and this reinforces that. Might also help some sleep challenged people avoid, reduce or eliminate their need for assistance from a prescribed drug.

I am not sure if the fact that the significant majority of the study were women vs a 50%-50% split is important in this case?

I know for me long walks at a good clip in the fresh air always seems to help.

Don't kid yourself...

This short report points out what we sometimes forget - you need the proper amount of sleep for the normal function of your brain and body, whether you choose to believe it not.

You are only fooling yourself if you think otherwise (and I've been there, done that, got the t-shirt... :-) )

Collateral Damage

As obvious as this article might be, it serves as a great reinforcement of one of the many kinds of "collateral damage" that a lack of sleep causes (as my spouse can attest there are a few...).

I know when my sleep problems arise again (as they are now - the medication's effect seems to be decreasing and my internal alarm clock seems to think 5:00 AM is the right time to rise) my outlook is greatly coloured in a negative fashion. Which leads me back to this study that reinforces what many have experienced anyways - the less sleep, the more bad attitude we have about things that normally we take easily in stride., like our jobs.

I wonder if those of us who are sleep deprived should have a warning label about volatility at times :-)

Sleep Better (!)

This site has some good information about getting a good night's sleep. Yes, they are trying to sell some pillows (I don't have any of their pillows, nor any of their stock :-) ) but that should not take away from some of the good information contained here. For example their 17 Healthful Sleep Tips is a good list to keep in mind when you are trying to get a good sleep.

Shifts and Sleep Disorders

(An excellent guest post by Sarah Scrafford)

We spend most of our lives sleeping, and if we did not, we would all live shorter and unhealthy lives. Sleep is extremely essential for both the physical and mental well being of each and every human being. While some people are able to get by with just 4 or 5 hours of sleep each night, others require a full 8 hours to function well the following day.

And then there are others who are forced to alternate sleeping patterns as often as every fortnight or month – people who work shifts; they have to adjust to changes in their days and nights, changes in the times they sleep and the times they work, and changes in their internal clocks. This destructive pattern not only wreaks havoc on productivity at the workplace but also causes untold damages to the shift workers’ health.

Shift workers are deprived of sleep because they have trouble falling asleep when their regular sleep timings are disrupted every two weeks or every month. Those who work nights are at a bigger disadvantage as they have to try and sleep peacefully when almost everyone else around them is awake. Noisy environments, intrusive phone calls and light streaming in through cracks in drawn curtains do not make a conducive atmosphere to catch a few hours of restful shuteye. Darkness, which induces the hormone melatonin and causes drowsiness, is essential for a good night’s sleep. Night workers are deprived of this vital ingredient in the recipe for continuous and restful slumber.

Sleep deprivation causes mistakes and accidents to happen in the workplace, sometimes mishaps with irreversible consequences. It also weakens the shift workers’ immune system and makes them more susceptible to colds, fevers and other ailments, induces headaches and migraines and causes a decrease in concentration levels and unexplained tiredness and fatigue. Social events and activities are affected too, as people who work night shifts are awake when their friends and family sleep and vice versa.

The time period when shifts change is especially stressful, as are the days that follow when the body is trying to accustom itself to a pattern that’s alien to its internal circadian rhythm. Shift changes entail continuous hours of work that span and overlap two shifts, and these are followed by hours of trying to fall asleep in the dark or light just as the body was getting used to the other.
The problem is compounded by short term solutions like drugs that help to stay awake and those that induce sleep. Any chemical that’s foreign to the body’s natural processes and fluids is dangerous as it can cause addiction and its associated complications in the long run.

Shift workers could try to better their situations by asking for longer time periods between changes in shifts so that their bodies are not put through the ordeal of constant adjustments between night and day. If they are working nights, they can turn off the telephone, insist that friends and family do not disturb them, and sleep in a dark room with drapes drawn over the windows.


Sarah Scrafford is an industry critic, as well as a regular contributor on the subject of RN. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com.

If only it were so simple...

This article and its great reminder of the health effects of too little sleep (get help!!) also refers to another article which outlines how so many suffer from anxiety over the pressure to get to sleep, watching the clock and so forth. It seems to refer those sufferers to good sleep hygiene habits and notes that "We should stop looking at insomnia as a medical problem".

If only insomnia could be solved by having good sleep hygiene alone. There is no doubt that sleep hygiene should be a big part of any sleep strategy, but for so many it is not as simple as that. Drugs should always be a last resort and only used as long as needed vs as a long term habit, but to suggest that insomnia is "not a medical problem" seems to be a very simplistic view of the issue.

If nothing else it is a great reminder, as I have mentioned before, of "caveat emptor" (buyer beware) whereas anyone with sleep problems should do their own research and consult with their doctor and be very skeptical of quick or miracle cures. Another good piece of advice is that if something looks too good be true, it probable is not true at all.

I did, however, get a good chuckle about how sleep needs change as we get older and naps at work would be a good idea (though likely not accepted). Imagine.... :-)

Some Success...

I have lately gotten better sleep than I have for quite awhile. Combining a focus on sleep hygiene, including a more or less consistent bedtime, and doing Sudoku puzzles on paper in bed until my sleep medication kicks in (and which seems to be helping me to not surface from sleep very often now) has yielded some good results. I will also put on some gentle music in the background (for about 40 minutes, on a timer) to also help me drift off to sleep.

I take the medication at bedtime and not before so that as soon as it starts to work I can just turn off the light and close my eyes.

Staying awake is important too...

I know, I know, this is supposed to be about how to GET sleep, but it might be helpful to read about some things people do to stay awake when working when you have not gotten enough sleep. This article has some interesting tips which boil down to (depending on your circumstances):

1. Stand up
2. Take a nap (NOTE: Careful here as this could also interfere with getting to sleep later)
3. Change your scenery
4. Keep busy
5. Eat something
6. Crank up the music (for those few who can at work)
7. Find a job you enjoy

The Business of Sleep Disorders

This is an interesting blurb hawking a report on the pharmaceutical market for sleep disorders.

Interesting info on Ambien IR losing its patent and the expectation of what generics will do in its place.

Position, Position, Position

Although I suspect that many who write articles on dealing with sleep problems don't actually experience the issue themselves, I think that the point that drugs should be a last resort and not taken forever is fair advice for some.

For example, there is great information in this article about the position of your head and body when in bed (and thus the title of this post :-) ) .

There are two main tips to remember:

• spine placement is important and therefore the fetal position on your side is best for your normal spinal curves. A small pillow between your knees or thighs to prevent shifting from that position is recommended. Sleeping on your back is almost as good (I don't like it myself) if you have something supporting the small of your back.
• the right pillow to keep the correct posture is important, keeping the proper alignment of your neck and head while you sleep. Sleeping without a pillow is not recommended.

Sleep Interrupted: 83 Sleep Disorders

You could be doing more than just not getting a complete sleep when you don't sleep well. What this article, summarizing findings published in the journal Sleep, says about the effects of sleep interruptions is a good warning for everyone. Not having enough sleep (which varies depending on your specific sleep needs) can cause:

• lower levels of serotonin which are associated with anxiety and depression
• obesity
• less body repair while sleeping
• increased risk of cancer (due to disruption of melatonin production)

A good sleep is important for all ages, especially children.

The point was made that the five stages of sleep are all very important:
1 - Transitional Stage
2 - Light Sleep Stage
3 - Delta Sleep 1
4 - Delta Sleep 2
5 - REM Sleep

Apparently sleep medicine is becoming a fast growing speciality. We are going to need all these new specialists to deal with the noted 83 (!) sleep disorders that are out there. Very comforting to know about this interest in sleep medicine for those of us with sleep problems.

The article has other information that I did not repeat here but could be of value to you so I strongly encourage you to read it if you have the time.

The bottom line is: If you are having sleep problems - GET HELP!

Magic Sleep Solution or Wishful Thinking?

I have to admit to being very skeptical of this article, which indicates that a product called SmartSilk, invented by Montreal's Harry Walker, has, and I quote, resulted in "... restful sleep with no snoring, sleep apnea, stuffy noses, night-time coughing or overheating"

Now, I have no doubt that this leading-edge product, that has just been awarded the Asthma and Allergy Friendly certification, does all the things it says it does in terms of blocking dust mites and pet dander, ability to pull away moisture, is made of safe materials and so forth. In fact I believe everyone should have SmartSilk or a similar product for all those reasons. I am also especially proud to see that this fantastic product was invented by a Canadian.

However, the article's (but not the product's website) assertion about all the sleep problems it will solve causes me some concern. I sure would want more information before acquiring this product on the hope that it would solve a snoring or sleep apnea problem, both of which can have serious effects on one's health if not properly treated.

Belated Happy World Sleep Day 2008!!!

World Sleep Day was March 14, 2008 (though I saw a conflicting article suggesting it was today, March 21, 2008).

What caught my eye when reading about World Sleep Day was this article from a Beijing news site which sure puts things in perspective. There are more people with insomnia (300 million....yes, million....) and snoring issues (200 million) than the entire population of most countries (and combined more than most continents)!!! Even sleep apnea affects more than 50 million citizens of China!

With that kind of market awaiting those who come up with successful solutions for sleep problems such as apnea and insomnia, I would expect even more business investment for such a potential return. Unfortunately there is also this same market for snake oil sellers as well, so we all still need to abide by caveat emptor.

Sleep Deprivation a Myth!?!?

A study performed by the U.S. Bureau of Labor Statistics and U.S. Census Bureau, as well as through time-use diaries collected by UM researchers, shows that Americans sleep as many hours now as 40 years ago - on average over 8 hours a night (check the story here). It is important to note that they are not saying that sleep disorders such as insomnia and waking up often are not being suffered out there by many.

This contrasts significantly with the National Sleep Foundations' findings of under 7 hours of sleep on average. Their stats, some would say suspect stats as the Foundation is partially funded by drug companies, tried to take into account the quality of sleep and whether the sleep was broken up and so forth.

Its interesting how your own personal situation colours your view of these reports. As someone with sleep problems, I am very skeptical of the claim that the majority of Americans (note: I am Canadian but I don't think when it comes to sleep we are any different than our neighbours to the south) are having over 8 hours of sleep on average. Anyone with a job and/or going to school would think that an 8 hour sleep was some sort of myth for most if not every night of the week :-) However, those lucky enough (and good for you!!) that are able to achieve that much sleep a night would think that the results make perfect sense.

Not much of a factor either way for those with sleep disorders, but interesting reading nonetheless :)

Sleep and Appetite

It seems that everything is related to our quality of sleep. This article explains how the lack of sleep triggers a hormone in the blood that stimulates appetite and a desire for high-calorie food.

Another article I read indicates additionally that the lack of sleep also suppresses a hormone that tells the brain to stop eating. I was not aware of this until now so paying attention to food choices especially when not sleeping well is clearly very important as you run the risk of adding further health challenges if you have an unhealthy diet.

"I realize now it was definitely the lack of sleep that was having a huge impact on my life."

As with all other health issues, it is heartening to see that it's not only apparent that "Sleep research has exploded in recent years as a result of busy lifestyles that have cut into sleep time." as noted in this article in the Globe and Mail, but that any differences between the sexes in this regard are also being explored. Women are harder hit than men when it comes to the impact of problems sleeping and the resulting health problems. It notes:

Researchers from the Duke University Medical Center in Durham, N.C., compared sleep patterns in a group of men and women and found that women who slept poorly had significantly higher levels of biomarkers that are associated with an increased risk of heart disease and Type 2 diabetes. Women who slept poorly were also much more likely to experience hostility, distress, depression and anger, according to the study.

The article does not go on to explain what might be the cause of this finding.

The title quote for this posting was also taken from the same article and I could not have said it better myself. Hopefully as sleep issues are being reported on by the press and other sources, those who have problems with sleep will be made aware they are not alone, and their options to try and address the problem; especially women.

Okay, so what's working and what's not...

I would boil down the strategies to deal with sleep problems (in my case staying asleep) to these three:

1) Good sleep hygiene
2) Control your environment
3) Drug assistance

For myself, I have been trying very hard to develop and maintain good sleep hygiene habits such as not taking naps, not lying in bed unless sleeping, not watching TV in bed, having a regular bedtime (this one's tough), and so forth. Although I can't say for sure this is helping, I know it is not hurting my overall goal of a better sleep.

As for environmental control, the temperature is lowered at night, the bed and pillow are comfortable, the room is dark and the house is normally pretty quiet (unless the wind comes roaring in and makes such a racket I need to relocate to the leeward side of the house :-) ). Again, mixed results as I have always done this though my efforts must be helping.

As for drug assistance, I did seek assistance from my doctor and have been trying a prescription which I believe, combined with the other two strategies, is helping me stay asleep more than I have in the past.

I am hoping that continuing to adjust my application of the above three strategies will improve the quality of my sleep in the long run. That is something I dream about.... :-)

Springing ahead to lose sleep

Spring ahead this weekend means we all lose an hours' sleep. Great, just great..... :-)

Wow, this is scary...

Apparently physicians are not getting enough sleep, according to this recent article from Science Daily. I have always wondered how wise it was to have someone performing such critical tasks for the health and well-being of our loved ones to be pushed to the limits like I understand still happens. I am not a doctor or even in the medical field and I am sure there are many reasons this is done, but I wonder if those reasons outweigh the risks they pose?

I found it quite interesting to read how those practices during their intense training and actual practice may desensitize those same doctors to the importance of sleep. How ironic as I am one of so many who have sought assistance from a doctor for sleep problems (and have no complaints about the help I have received to date I should note).

It is curious that the article notes the "chronic low-level sleep deprivation" experienced by physicians greatly reduces their complaints of insomnia and notes that few indicated this problem affects their work performance and where more indicated an impact in their family life. Family life, for the health of these same doctors, should be just as important as for the rest of us.

I wonder if, in a world where we (rightly in my opinion) limit the number of hours a truck driver, pilot and other such hardworking people can work in a row for safety reasons, society should look at the same concerns for the medical profession? I am fully aware that my effectiveness and performance is impacted when I feel tired and I do not even have a job where the health and well-being of a fellow human being relies on my performance.

National Sleep Awareness Week

Woohoo!!!! It's National Sleep Awareness Week in the United States this week, March 3 to March 9. What a great idea to further raise awareness about the importance of sleep for everyone, the impact if you don't have proper sleep habits/hygiene, and the work being done to help with sleep disorders.

Nothing but good can come from this :-)

Sleep in the headlines

It is nice to see that the issue of sleep, or lack thereof, seems to be coming to the forefront. Just today I saw a piece on NBC News about the quality of sleep and adults. This seems to be the result of a recent CDC study that many media outlets are reporting on right now. The National Sleep Foundation website is also referred to quite often and looks to be a great resource as well. It is wonderful to see all this focus on a problem which afflicts millions of people.

Another reason to look forward to retirement!!!

Although I am not wishing my life away there certainly are reasons I am looking forward to retirement, sleeping in being but just one :-)

I always thought living where I do now was some horrible mistake and that I was born to live in Hawaii. Happily this report from ABC News, which indicates that retirement and a better sleep seem to go together, also reinforces how Hawaii is a great place for getting more sleep!!! What a pleasant coincidence :-)

Its 22 minutes after midnight....

....do you know where your sleep is? As someone who does not take a good night's sleep for granted and who was awake at 00:22 AM this morning involuntarily, I have sympathy for those who suffer from sleep apnea. As I understand it, not only is someone who has sleep apnea not getting a good night's sleep, they are also in danger of developing other problems as well. I hope everyone who knows they have sleep apnea gets the required treatment, and those who suspect they might get immediate assistance to diagnose and treat that condition.

A theory on sleep from Down Under

I just finished reading this article written by an insominac from Down Under which outlines a theory regarding our sleep expectations today. It boils down to the suggestion that the eight hours of restful sleep is as much a creation of commercial interests (bed manufacturers, drug makers, and other sleep aid and therapy commercial interests) as anything else, and that a poor night's sleep was not uncommon in human history.

Although I do not doubt that insomnia, at any level, was not unknown to ancient civilizations, I still believe that problems sleeping is just one of the many effects of the modern age (caused by such things as electric light, our many distractions and demands on our lives, stress, pressure, and so forth) and has indeed increased over time.

The point made in the article is certainly well-made, however, that those having problems getting a good night's sleep have to be very wary of the solutions offered out there as so many do not even deliver on a temporary deliverance to the land of a sound and restful sleep.

Sleep and food

I just read this article about being careful about what you eat when before going to sleep. One of the concerns being Gastroesophageal reflux disease (GERD) causing sleep disruption.

I am pretty sure that this has not been a problem for me but I do find if I eat some foods to close to bedtime I have an even greater problem getting any sort of good sleep that night.

Begs the question why I keep doing that on occasion.... :-)

Drugs vs Therapy

I have done a lot of research on the internet about getting a better sleep. Today I just came across this blog post on the NY Times site which includes some interesting links about studies showing how cognitive behavioral therapy in some cases was as helpful as a drug.

These articles speak about how such therapy is just effective at getting you to fall asleep as medication. That is all well and good but what about someone such as myself that falls asleep, wakes up, gets back to sleep, wakes up etc multiple times during the night?

This other article I found that was a link on the above noted NY Times blog post, talks about sleep medication specfically. Again the focus is on how soon the person falls asleep and when they get out of bed the next day, missing the issue of STAYING asleep during the night. The article does make good note about the concerns about medication as well, which are very important.

I would love to have a full night's sleep based solely on good sleep hygiene but it is just not that simple for me (and I imagine I am not alone) so something that helps me stay asleep during the night is what I need.

All I Want Is Some Sleep

Have you ever watched those commercials on TV where the person wakes up well rested and refreshed from a great night's sleep? Have you ever wished that was you? I know I have for many years as I am a very light sleeper and I have nights of a thousand naps and not one long restful sleep. I can likely count on one hand the number of good sleeps I have had in any given year.

I am going to utilise this blog to outline what I have done to try and address this problem as I am not the person I like to be when I am always really really tired. I have seen so many results from my search for solutions where people were asked if they had troubles sleeping and/or were light sleepers (with lots of responses showing a lot of people out there) but not always much info on experiences trying to combat this problem. I know I would find it very helpful if there was one place where I could find out what techniques have worked and what have not. I am going to try to pull such information together here.

At the very least this will be a great reference for me to keep track of what I have done :-)