10 Silent Symptoms of Diabetes

112316_briers_bioAlexa Briers is currently a Dietetic Intern with REX Nutrition Services and REX Diabetes Education Center. She is a graduate of Virginia Tech.

Do you have undiagnosed diabetes? The American Diabetes Association reported 29.1 million Americans had diabetes, with 8.1 million being undiagnosed in 2012. Additionally, 1.4 million Americans are newly diagnosed each year.

In recognition of National Diabetes Awareness Month, we want you to monitor for these 10 subtle signs of diabetes. If you have questions or concerns about diabetes, talk with your doctor and ask about getting your blood glucose checked.

  1. Frequent urination: Your kidneys are working overtime to flush out excess sugar in the blood. Extra sugar not absorbed by the kidneys are filtered out through urine. High sugar equals more bathroom breaks.
    1. How do you know? People urinate 4-7 times in a day; are you making more trips to the bathroom?
    2. RED FLAG: Waking at night to use the bathroom.
  2. captureExcessive thirst: With frequent urination comes replacing the fluid lost. Your body feels parched and dried out!
    1. How do you know? 4 or more liters, over a gallon per day, is excessive. The average person needs approximately 2 liters a day.
    2. RED FLAG: Feeling thirsty just after drinking water.
  3. Extreme hunger: When blood sugar isn’t properly regulated it leads to fluctuations throughout the day. Low levels tell the brain to eat more calories and sugary food.
    1. How do you know? You find yourself eating more times a day than usual.
    2. RED FLAG: Extreme hunger even after a meal.
  4. Weakness/fatigue: Sugar is unable to get into your cells to energize them. The kidneys are also working overtime with sugar highs and lows. Add in interrupted sleep from night time urination and you are exhausted!
    1. How do you know? Your body and mind feel an ongoing exhaustion, lethargy or weakness.
    2. RED FLAG: You find yourself too weak to do everyday activities you were able to do with ease before.
  5. Pins and Needles: Extra sugar in the blood is damaging the nerve and nerve-endings. Due to poor circulation, the nerves located farthest from the heart, typically the hands and feet, have difficulty being repaired.
    1. How do you know? Feeling numbness or tingling in the hands and feet.
    2. RED FLAG: The tingling or numbness feels like burning upon waking up.
  6. Blurry vision: The sugar lingering in the blood takes fluid from the cells and tissue of the eyes. This leads to swelling, making focusing difficult for your eyes.
    1. How do you know? Road signs, menus, books or computer screens are not as clear.
    2. RED FLAG: Floaters in the field of vision.
  7. captureItchy skin: Poor circulation paired with the extensive loss of fluids causes the skin to dry out. Dry skin leads to itchy skin.
    1. How do you know? You notice yourself itching more than usual, coupled with noticeable dry skin.
    2. RED FLAG: Constant need for lotion and cracking skin.
  8. Slow healing wounds: Again, lingering sugar in the blood wreaks havoc on veins and arteries disrupting circulation. Without proper blood flow, cuts and bruises heal more slowly.
    1. How do you know? Paper cuts, bumps and bruises are taking more than a few days to go away.
    2. RED FLAG: Cuts that scab over again and again or wounds lasting weeks to months.
  9. Moody: Riding the roller-coaster of unstable blood sugar may cause a short-temper. High blood sugar may even disguise as depression symptoms.
    1. How do I know? You are noticeably more grumpy or irritable. Family or friends may comment on your unusual demeanor.
    2. RED FLAG: Depression-mimicking symptoms such as low energy drive and feelings of staying in bed.
  10. UTIs & yeast infections: High sugar levels within the urine are a breeding ground for bacteria and yeast near the genitalia.
    1. How do I know? Urinary tract infections come with a burning sensation during urination and cloudy, dark, or off-smelling urine. Yeast infections come with itching, burning and discharge.
    2. RED FLAG: Regularly occurring UTIs or yeast infections. Diabetics are 2 times as likely to suffer from these.

Only your healthcare provider can diagnose diabetes. Once diagnosed, our REX Diabetes Education Center can help you manage your  diabetes through individual and group support. To learn if you are at risk for diabetes, take our free online health assessment today.

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REX Bariatric Specialists Quick Recipes

Spice up your meal variety with these healthy, quick recipes recommended by REX Bariatric Specialists!

Ham, Egg, and Broccoli Casserole

Ingredients:

  • 12 eggs
  • 16oz low fat cottage cheese
  • 1/2 cup whole wheat flour
  • 1 tsp baking powder
  • 2 cups 2% Italian cheese blend
  • 2 cups low sodium chopped sliced ham
  • 1/4 cup chopped green onions
  • 10oz chopped frozen broccoli
  • pinch of salt and pepper

Directions:

  • Beat eggs in a large bowl until blended
  • Add remaining ingredients into bowl and mix until combined well
  • Spray 13×9 inch baking dish with olive oil cooking spray
  • Pour mix into baking dish
  • Bake at 350°F for 50- 60 minutes


Oatmeal Pancakes

Ingredients:

  • 6 egg whites
  • 1 cup rolled oats, dry
  • 2 tsp Stevia (optional)
  • 1 tsp cinnamon
  • 1 tsp vanilla extract
  • 1 cup low fat cottage cheese
  • fruit (raspberries, blueberries)

Directions:

  • Combine ingredients into a bowl and blend
  • Spray skillet with olive oil cooking spray
  • Pour 1/4 cup of batter onto medium-low heat skillet
  • Flip batter when it begins to bubble
  • Repeat with rest of batter
  • Top finished pancakes with fruit

Serving size: 4 pancakes


Moroccan Chicken Thighs (slow cooker meal)

Ingredients:

  • 1 cup fresh cilantro
  • 3 garlic cloves
  • 3/4 tsp cinnamon
  •  1 tsp cumin
  • 1 tsp paprika
  • 1 tbsp extra virgin olive oil
  • zest of 1 lemon
  • juice of 1 lemon
  • 1 1/4 lbs boneless, skinless chicken thighs (trimmed of excess fat)
  • pinch of pepper
  • Greek yogurt (for garnish)

Directions:

  • Blend cilantro through lemon juice in a food processor or blender
  • Add chicken thighs to bottom of slow cooker pot
  • Season with pepper and cover chicken with paste from food processor
  • Cook on low for 3-4 hours
  • Serve with a dollop of Greek yogurt


Hummus and Crackers

Ingredients:

  • Crackers:
    • 1/2 cup chia seeds
    •  1/2 cup hulled sunflower seeds (unsalted)
    • 1/2 cup pepitas
    • 1/2 cup sesame seeds
    • 1 clove of grated garlic
    • 1/4 tsp sea salt
    • 1 cup water
  • Hummus:
    • 15oz canned chick peas (drained)
    • 15oz canned chick peas (with liquid)
    • 1/4 cup tahini sauce
    • 1 tbsp olive oil
    • 3 tbsp lemon juice
    • 2 medium garlic cloves (peeled)
    • 1/4 tsp cumin
    • dash of cayenne pepper
    • 1/2 cup kalamata olives (rinsed, pitted and chopped)

Directions:

  • Combine all cracker ingredients in a bowl and stir mixture until combined
  • Let sit for 2 minutes so water absorbs
  • Spread mixture onto baking sheet lined with parchment paper
  • Bake at 300°F for 35 minutes
  • Remove from oven and cut sheet into squares with pizza cutter
  • Flip squares and bake again at 300°F for 25- 35 minutes
  • While crackers are baking, combine all hummus ingredients into a food processor and blend until smooth
  • Pour into a bowl and refrigerate while crackers finish baking (optional)
  • Garnish with additional olives (optional)

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Breast Cancer Myths vs. Facts

In honor of Breast Cancer Awareness Month, we want to dispel some common myths about breast cancer that you often hear.

Myth: All lumps are cancerous.

Fact: Only a small percentage of breast lumps turn out to be cancer.  But if you discover a persistent lump in your breast or notice any changes in breast tissue, it should never be ignored. It is very important that you see a physician for a clinical breast exam. He or she may possibly order breast imaging studies to determine if this lump is of concern or not.

Myth: Only women get breast cancer.

Fact: Each year it is estimated that approximately 2,190 men will be diagnosed with breast cancer. While this number is still small, men should also check themselves periodically by doing a breast self-exam while in the shower and reporting any changes to their physicians.

Myth: If you have a family history of breast cancer, you are likely to develop breast cancer, too.

Fact: While a family history of breast cancer can place you in a higher risk group, most women who have breast cancer have no family history. Statistically only about 10% of individuals diagnosed with breast cancer have a family history of this disease.

Here are the familial risks of breast cancer according to degree of family relation:

  • If you have a first degree relative with breast cancer: If you have a mother, daughter, or sister who developed breast cancer below the age of 50, you should consider some form of regular diagnostic breast imaging starting 10 years before the age of your relative’s diagnosis.
  • If you have a second degree relative with breast cancer: If you have had a grandmother or aunt who was diagnosed with breast cancer, your risk increases slightly, but it is not in the same risk category as those who have a first degree relative with breast cancer.
  • If you have multiple generations diagnosed with breast cancer on the same side of the family or if there are several individuals who are first degree relatives to one another, or several family members diagnosed under age 50, the probability increases that there is a breast cancer gene contributing to the cause of this familial history.

Fact: Early Detection is Key

When it comes to breast cancer awareness, the most important thing to remember is that early detection is key. According to the National Breast Cancer Foundation, when breast cancer is detected early and is in the localized stage, the 5-year relative survival rate is 98%.  Early detection includes doing monthly breast self-exams and scheduling regular clinical breast exams and mammograms.

Learn more about the REX Comprehensive Breast Care Program and how to make an appointment for a mammogram at rexhealth.com.

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CPR in 3 Simple Steps

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Sudden cardiac arrest occurs when the heart suddenly stops beating and the victim loses consciousness and collapses. It isn’t always caused by a heart attack. Nationally, if a victim of sudden cardiac arrest collapses outside of a hospital, his/her chances of survival if a bystander does not start CPR immediately is less than 8%. You can double or triple a loved one’s chances of survival by starting CPR.

These are 3 simple steps to save a life if you see a teen or adult who has collapsed:

  1. Check to see if they are responsive and breathing normally.The best way to determine if someone is unresponsive and may need CPR is to tap the victim and shout “Are you OK?” while checking to see if they are breathing normally. Breathing normally does NOT include snoring, gurgling, or gasping.A victim must be on his/her back on a hard flat surface, preferably on the floor, for CPR to be effective.
  2. Call 911.
  3. Compress hard and fast on the center of the chest.Interlock fingers and place palm of one hand over the center of the victim’s chest.Keeping arms straight and elbows locked, push straight down hard – at least 2 inches. It is better to push too deep than not deep enough.The hands should not come off the chest or “bounce” between each compression, but downward pressure should be completely released to allow the heart to refill with blood.Push hard and fast in the center of the chest (about 100 times per minute) when doing compressions on an unresponsive victim who is not breathing, or not breathing normally once 911 has been called. Do not stop until help arrives, unless the victim begins moving or speaking.

Stop by our booth at the North Carolina State Fair now through October 23, 2016, and we can teach you how to save a life!


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Education Building (near Gate 12), Booth 37-38
1025 Blue Ridge Road, Raleigh, NC 27607

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Pumpkin is the New Black


Jayne VecchioJayne is a graduate of Virginia Tech and is currently a Dietetic Intern through Meredith College, working with REX Nutrition Services and REX Diabetes Education Center.

Pumpkins are nutrition-packed vegetables that seem to be underrated for the majority of the year- until fall rolls around. As you may have noticed, pumpkin is currently taking over grocery stores and coffee shops and the smell of pumpkin spice lingers in the air.  It is high in fiber, low in sugar and fat, and contains many micro-nutrients the body requires to function.

Here are some of the main nutrients pumpkin provides:

  • pile of pumpkinsVitamin A – aids in vision (1 cup mashed pumpkin contains more than 200% RDI)
  • Vitamin C – can help boost immune system
  • Beta carotene – a powerful antioxidant that helps fight disease
  • Fiber – keeps you fuller longer and can aid in weight loss
  • Phytosterols – Can reduce LDL (bad) cholesterol levels
  • Tryptophan – an amino acid that helps calm and relax body

One of my favorite ways to get in the fall spirit is incorporating pumpkin into baking.  Simply adding of a cup of pumpkin puree to recipes is as a more nutritious way to enjoy a sweet treat (in moderation)! Pick up a can of pumpkin (or a pie pumpkin to steam if you prefer the old-fashioned way) at your local grocery store and try this recipe this weekend:

Pumpkin Banana Muffins

pumpkin banana muffinsIngredients:

  • ¼ cup butter
  • 2 ripe bananas
  • 1 cup sugar
  • ¾ cup canned pumpkin
  • 1 egg
  • 1 teaspoon vanilla
  • 1 ½ teaspoon pumpkin spice
  • 1 teaspoon cinnamon
  • 1 ½ cups flour
  • ½ teaspoon salt
  • 1 teaspoon baking soda

Directions

  • Preheat oven to 425° and line a muffin tray with liners.
  • In large bowl microwave butter until melted, about 15-20 seconds, then add the bananas and mash. Add the sugar and pumpkin. Stir well.
  • Stir in the egg and vanilla.
  • Mix in pumpkin spice, cinnamon, flour, salt, and baking soda.
  • Spoon evenly into a muffin tin

Bake for 5 minutes at 425°, then reduce the heat to 350° and bake for 15-16 more minutes. Baking them at the higher temperature at first helps them rise and gives a nice rounded top.  Remove from tin and allow to cool then enjoy!

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Lessons from a Mock Triathlon

Post by Rodney Jenkins, a Group Exercise Instructor at the REX Wellness Center of Garner. He is also a business teacher, a soccer coach and an athletic trainer with the Wake County Public School system.

On September 4,  seventeen determined athletes participated in the Knightdale Wellness Center Mock Triathlon. Over the past few years, we have held this event at our centers to help members prepare for race day.

Participants have an opportunity to participate in the entire swim, bike and run course without the pressures associated with an actual race. We start in the pool with staggered swim starts (every 30 seconds a swimmer begins), we have a transition area and we cycle and run the entire course. New cyclists and runners are partnered with experienced triathletes so we run a very safe event.

However, the Knightdale event was a little different. Instead of being the instructor, I became the student because several members taught me something new about the sport of triathlon. As we started the swim, I asked each person about themselves and this is what I heard:

  • Swimmer #1:“I was recently in the hospital for a month.”
  • Swimmer #2: “Cancer survivor.”
  • Swimmer #3: “I was in a serious automobile accident but I’m back.”
  • Swimmer #4: “I’ve never done this before so I want to see if I can do this. I’m not even registered for the race.”

So what did I learn? The triathlon can be so much more than an athletic event. It can be a reaffirmation that life’s challenges may cause one to stumble but not fall. Thanks all for sharing your stories and I can’t wait to see all of them again on September 19 at the Rex Knightdale Triathlon.

Rodney and fellow participants in the Knightdale Mock Triathlon

Rodney and fellow participants in the Knightdale Mock Triathlon

The REX Wellness Sprint Triathlon- Knightdale is on Sunday, September 18.

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Improving Care for Patients with PAD through Research

pad2016-digital-signage

Peripheral artery disease (PAD) affects an estimated 8 million people in the U.S. However, severity of symptoms can vary widely.

Patients with relatively mild PAD may experience cramping in their limbs during exercise—known as claudication. Patients with the most severe PAD are afflicted with ischemic ulcers and gangrene as cells and tissues that are deprived of oxygen-rich blood begin to die.

Several devices, like stents or balloons, are available to help relieve the blockages that cause PAD. But because most of the data on their use comes from clinical trials aimed at regulatory approval, and because such trials utilize patients with a relatively standardized severity of symptoms, there is often little guidance for clinicians whose patients have milder or more severe PAD.

One UNC REX Healthcare doctor is leading the effort to change that.

George L. Adams, MD, MHS, FACC

George L. Adams, MD, MHS, FACC

George Adams, MD, MHS, Director of Cardiovascular and Peripheral Vascular Research at UNC REX Hospital, is leading a prospective, observational, multicenter study called LIBERTY 360. In February 2016, the study completed enrollment 1,204 patients at 51 sites across the U.S. The enrolled patients had symptoms that ranged from mild to severe (physicians use the Rutherford scale to rate severity) requiring endovascular treatment for an arterial blockage located within the target area beginning slightly above the knee, through the foot.

“In the guidelines currently, you are supposed to manage the symptoms of patients with mild PAD and amputate in the most severe cases,” said Adams. “So the question we’re trying to answer is if we accept all classes of patients, what can we do for them and what is the outcome?”

The study hopes to gather data on the clinical and economic impact of endovascular device interventions – like stents or balloons – by following patients for up to five years. During that time, patient risk scores will be developed as a clinical predictor of outcomes to provide guidance for future interventions.

Initial 30-day results, which Adams recently presented in a late-breaking presentation at the Amputation Prevention Symposium in Chicago, have already suggested a new way of looking at treatment.

The results saw quality of life improvements in patients from across the Rutherford scale. “The take home message is maybe we should be intervening earlier and trying to intervene in more severe cases,” said Adams.

Ideally, intervening with endovascular devices among a wider range of patients will improve outcomes all around, including reducing the number of amputations required in patients with the most severe PAD. But for now more data need to be gathered.

To find out if you are at risk for PAD, please take our free online health risk assessment. To learn more visit rexhealth.com.

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Bee Sting or Back-to-School Bug?

REX Express Care of Raleigh

REX Express Care of Raleigh: 3050 Duraleigh Road

With the beginning of the school year, many families are juggling new schedules. When a family member gets sick or injured, it can throw even the most organized among us for a loop.

Regardless of the ailment, our REX Express Care team is here to help you at our new Raleigh location at 3050 Duraleigh Road.  We’re open seven days a week from 9 a.m. – 8 p.m.

REX Express Care is available to help treat conditions that can come up suddenly and get you or your loved one back into the routine quickly. With five convenient locations throughout the Triangle, we’re close to home, school or work.  Check the estimated wait time for a location near you at rexhealth.com/wait-times.

Lab and X-ray services are also available onsite for your convenience. Our care team provides services and treatments for common conditions, including:

  • burn/wound care
  • cold/flu
  • earaches/ear infections
  • insect bites/stings
  • minor lacerations
  • seasonal allergies
  • skin rash/poison ivy
  • sore throat/strep throat
  • mild asthma
  • sutures
  • sports physicals
  • UTI/painful urination

We are here to help you feel better, faster!

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Getting to Know PAD

Lori Adkins_croppedLori Adkins graduated in 1998 with a BA in Speech Communications from UNC Chapel Hill. After working in the pharmaceutical industry, she returned to school and received an associate in Science in Nursing Degree from  Wake Technical Community College in May 2013.  She is currently pursuing a BSN  from UNC Wilmington.
Over the past three years, Lori has worked with multiple cardiac populations including CHF, CABG, PCI and Arrhythmia  patients.  She enjoys helping her patients understand Cardiac Risk factors. Lori is married and the proud mother of  two beautiful children.

About eight million Americans have Peripheral Artery Disease (PAD), and many people mistake the symptoms for something else. Pain, cramping, and tiredness of the leg, and/or hip muscles that increases with activity and decreases with rest are all signs of PAD. PAD often goes undiagnosed and puts patients at greater risk for heart attack. If left untreated, it can also lead to gangrene and amputation.  If the blockage occurs in a carotid artery, it can cause a stroke.  Managing PAD begins with knowledge. REX Vascular Specialists encourages you to learn all you can about PAD and other cardiovascular disease. Knowing your risk factors and living an active heart-healthy lifestyle may ward off this debilitating disease.

What is PAD?

clogged arteryPeripheral Artery Disease (PAD) is caused by fatty build-up, also known as atherosclerosis, in the inner walls of the arteries.  This build-up causes a blockage and affects normal blood flow.

Where does PAD occur?

Common sites for PAD are the iliac artery (in the lower torso), the femoral artery (in the groin), the popliteal artery (at the knee) and the tibial arteries (at the shin and calf). PAD can also occur in arteries of the kidney and other organs.

What are the symptoms of PAD?

Common symptoms of the early stages of PAD may include cramping, fatigue, heaviness and pain or discomfort in the legs and buttocks during walking or activity. The pain and discomfort usually goes away when activity stops. This is known as “intermittent claudication.”

How is PAD diagnosed?

PAD diagnosis begins with a medical history and physical exam. REX Vascular Specialists offer a comprehensive package of screenings along with a one-on-one results consultation. The comprehensive screening includes blood pressure, body mass index, full cholesterol panel, and ankle brachial indexes.  The ankle-brachial index (ABI) result is used to predict the severity of peripheral arterial disease (PAD).This test is done to screen for peripheral arterial disease of the legs. It is also used to see how well a treatment is working (medical treatment, an exercise program, angioplasty, or surgery).The ABI result can help diagnose peripheral arterial disease (PAD).

Why get screened for PAD?

PAD can affect vital arteries that lead to the kidneys, stomach, arms, legs and feet. If PAD is not treated, it can lead to gangrene and amputation of limbs. If the blockage occurs in the carotid artery, it can lead to a stroke. Most patients with PAD have a higher risk of death from heart attack and stroke.

To find out if you are at risk for PAD, please take our free online health risk assessment. To learn more visit rexhealth.com.

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Napping: Is it good for everyone?

woman napping hammock

Everyone knows long hours of sleep are essential for small children to grow up strong and healthy. But what about adults? A brief nap during the day can be the perfect solution for some. Dr. Adnan Pervez, a sleep medicine physician at REX Pulmonary Specialists answers four key questions about the health benefits and risks for taking a quick daytime snooze.

1. What are the benefits of napping?
Taking a short nap can offer health benefits such as:

  • Improved mood
  • Increased relaxation
  • Increased alertness
  • Reduced fatigue
  • Improved performance
  • Improved memory

“Memory consolidation is one of the major benefits of a good long night of sleep,” Dr. Pervez says.

2. Who should consider taking a nap and why should they?
Depending on your daily schedule, napping can be beneficial under certain circumstances.
Habitual napping
occurs when you take a brief snooze at the same time each day. “People who are consistently unable to get enough sleep at night would benefit from a habitual nap, taken at the right time and for the right duration,” says Dr. Pervez.

Planned napping is particularly useful for night shift workers. “For many people a nap before they depart for their night shift, or during a break in the early part of the shift, in combination with strategic exposure to light and use of caffeine at the right time can help them cope with an unusual schedule,” Dr. Pervez says.

drowsy drivingEmergency napping is advised when you’re too sleepy to continue a crucial activity, like if you feel drowsy while driving. “If drivers are feeling sleepy, they are typically advised not to rely upon extraneous measures like rolling down the window or turning up the music. Instead, we advise people to park at a rest stop and take a short nap before continuing,” says Dr. Pervez.

3. When and how long should you nap for?
For people who would benefit from napping, Dr. Pervez recommends a 10 to 20 minute nap in the early afternoon. At the most, try limiting your naps to no more than 30 minutes. “The longer or later we nap, the greater the chances that it may prevent us from going to sleep at a decent hour at night,” Dr. Pervez says.  Napping for longer periods can also cause sleep inertia (a state of feeling groggy and disoriented when awakening from a deep sleep) which may interfere with functioning in the period immediately following the nap.

woman_nappingIt is also important to remember that while short naps may be beneficial for some individuals, excessive napping may be a sign of serious medical conditions like sleep apnea or narcolepsy. Establishing consistency in your sleep habits is key to a healthy lifestyle. Both sleep deprivation and excessive sleepiness can have serious health consequences.

The recommended amount of sleep at night depends on a person’s age.  For example, adults between the ages of 26 and 64 should be getting 7 to 9 hours of sleep at night. View the National Sleep Foundation’s recommended sleep times chart for more details.

4. What kind of environment should we nap in?
Protect your time and environment; sleep in a dark and quiet area. Resting in a tranquil and dark room will increase your chances of falling asleep faster. Powerful sources of light in a room can have an impact on the quality of your sleep.

Light and darkness are strong signals that let your body know it’s time to rest. Your brain continues to process sounds while you’re sleeping. Noise can interrupt your dozing, leading you to wake up and shift between stages of sleep.

Learn more about our sleep services offered at the REX Sleep Disorders Center. Plus, find out if you’re at risk of a sleep disorder by taking our Sleep Aware health assessment.

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