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Strength training, or resistance training, is a type of exercise where you work your muscles by pulling or pushing against a force. The force can be your own body weight like when you do a press-up, free weights or a weight machine. 

The idea is that putting repeated, controlled stress on your muscles increases their strength and endurance over time. To get stronger, you gradually train with heavier loads over time, while reducing how many times you lift them.  

Having stronger muscles and a stronger body is a great complement to other exercises like running and swimming. And the best part is that you don’t need to be a bodybuilder or gym-goer to benefit. 

## What’s so great about strength training?

There are plenty of reasons people do strength training. The obvious ones are:

- To become stronger
- To lose weight or maintain a healthy weight
- To increase your fitness level 

But there are also some surprising extra benefits that make building muscle more important for your health than you might expect. 

## 1. You’ll boost your energy and mood
There’s growing evidence to say that activities benefiting your physical health are also great for your mental health, and strength training is one of them. 

[Studies show](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377696/) that a regular training program is associated with better mental health, higher energy levels and a positive impact on social relationships. These are all things that also protect your emotional wellbeing in the long-term. 

## 2. You’ll build stronger, healthier bones
You might not think much about your bone health – especially if you’ve been lucky enough to avoid any breaks or fractures. Strength training is a way to strengthen your bones before conditions like [osteoporosis](https://www.livi.co.uk/medical-advice/musculoskeletal-disorders/osteoporosis/) become a problem, especially as bone density declines as we get older. 

[One small study](https://link.springer.com/article/10.1007/s00198-010-1182-9) found that doing high-intensity resistance training for just 2 days a week helped combat the effects of ageing on bone density. The main benefits behind this are that having a strong skeleton protects you from injuries and means you can have a more active lifestyle for longer. 

## 3. You’ll reduce your risk of heart problems
Low to moderate intensity strength training lowers your risk of a [stroke](https://www.livi.co.uk/medical-advice/cardiovascular-diseases/stroke/), [heart disease](https://www.livi.co.uk/medical-advice/cardiovascular-disease/) and hypertension. A single session can lower blood pressure for up to 24 hours, according to [one review](https://pubmed.ncbi.nlm.nih.gov/27512052/). 

Even better news is that the effects of regular training translate into long term benefits. Lifting weights for less than 1 hour a week was linked to a [40-70% lower risk](https://journals.lww.com/acsm-msse/Fulltext/2019/03000/Associations_of_Resistance_Exercise_with.14.aspx) of heart problems in a recent study.

Remember, it’s a good idea to speak to a doctor before [using exercise to control high blood pressure](https://www.livi.co.uk/your-health/exercising-with-high-blood-pressure/) or manage a heart condition. 

## 4. You’ll lower your risk of type-2 diabetes
There are lots of things you can do to reduce your chances of getting [type 2 diabetes](https://www.livi.co.uk/medical-advice/type-2-diabetes/) and strength training has recently joined the list. Lifting weights can be a great way to take things into your own hands and [manage your blood sugars](https://www.livi.co.uk/your-health/what-you-need-to-know-about-blood-sugar/), whether you already have diabetes or not.

A [recent review](https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-021-00321-x) of 14 scientific studies of people at risk for diabetes found that regular training led to healthier blood sugar levels as well as a lower body fat percentage. That was all without needing to diet, although the more healthy lifestyle choices you make, the better.

## 5. You’ll be able to stay more active as you age
Once we hit 30-years-old, we shed between [3-8%](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804956/#:~:text=Muscle%20mass%20decreases%20approximately%203,to%20disability%20in%20older%20people.) of our muscle mass every decade. It’s part of the reason why some people lose their ability to get up and go as they age. 

Strength training is a way to turn things around and [recent studies](https://link.springer.com/article/10.1007/s40279-021-01605-8) suggest that it doesn’t need to be intense or difficult. Whether you’re younger or older, a small amount of light, regular training can keep your muscles in shape as you age. More intense strength training gives better results and more muscle mass.

## 6. You’ll have fewer aches and pains
Muscle weakness isn’t necessarily the cause of an injury, but building back muscle strength can help. [One large-scale review](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377696/) found that the biggest benefit of strength training was that people experienced less aches and pains. 

Strengthening your muscles protects your joints and ligaments and improves posture, all of which can lessen pain and reduce the risk of a future injury. 

## 7. You’ll have better balance
The last big benefit of strength and resistance training as you age is it improves your balance. This can help you avoid risky trips and slips. 

It can be daunting to get started with exercise if you already feel unsteady on your feet. A professional at most gyms can show you light exercises that can be done sitting down or using a weight machine for support as a start. Soon enough you'll be able to do standing exercises. 

## So, how do I get started?

There are a few things to think about when starting strength training, including:

- How heavy the weights should be
- How many times you lift them
- What type of equipment (if any) you should use
- How you change your routine over time

### Start simple
Experts recommend starting with a few rounds of exercises targeting different muscles. Aim to manage to repeat each exercise 8-12 times per round and if it’s too hard or easy, then you can adjust the weight you’re using. Too hard means you can’t do 8 and too easy means you can do more than 12.

### Don’t skip the warm up
To avoid injuries and progress over time, remember to always warm up and cool down. Similarly, using an exercise machine or working with a trainer can help you keep good form to avoid injuries if you’re a beginner. 

### Follow along
If you’re brand new to this, then the simplest solution is to find an app, online program or regular class that you can follow. The best ones will help you tailor it to your age, weight, goals and current abilities. If you want to pair your training with other activities then do a little research – there are plenty of strength training exercises for runners and different sports too.
## What’s the difference between strength and resistance training?
Resistance training describes the general exercise of working your muscles using an external force. That could be your own body weight, elastic exercise bands, free weights, or weight lifting machines. 

Strength training is a type of resistance-based workout where you gradually train with heavier loads over time, while reducing how many times you lift them. It’s been shown to be the best way of getting stronger. 

Training your muscles is also perfect for supporting other types of exercise, such as targeting certain muscle groups to [reduce the risk of running injuries](https://www.livi.co.uk/your-health/how-to-prevent-running-injuries/). 

## Do I need to speak to a doctor first?
For most people, it’s safe to start resistance training. What’s not safe for sure is staying physically inactive. 

However, there are a few cases where it’s a good idea to check with a medical professional first, for example: 

- If you’re making big lifestyle changes
- If you’re worried about an injury
- If you’re struggling to maintain a healthy weight
- If you’re pregnant or recently gave birth
- If you have a heart condition or high blood pressure

__This article has been medically reviewed by Lead Physiotherapist Erik Nordlund.__

livi.co.uk > CTA > Strength training

Speak to a GP

livi.co.uk > Your Health > Strength training

Benefits of resistance training

Strength training has far more benefits than just getting in shape. Here’s why, and how doctors recommend you get started.

livi.co.uk > Meta info > Strength training

7 benefits of strength training - and how to start | Livi UK

Livi.co.uk > H&L page > Medical review > Strength training

Erik Nordlund

Lead Physiotherapist at Livi

Health tips

7 benefits of strength training – and how to get started 

Keeping a good posture is something that can often be forgotten, especially when we’re busy working or on-the-go – but it’s essential for looking after your body’s musculoskeletal health. 

Musculoskeletal conditions are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. They add [up to nearly a third of all GP appointments](https://www.england.nhs.uk/elective-care-transformation/best-practice-solutions/musculoskeletal/)in England. 

Lower back and neck pain are also the biggest cause of years lost to disability in the UK, with chronic joint pain (or osteoarthritis) affecting more than 8.75 million people.

## Why is good posture important?

‘Although there’s no such thing as “perfect posture”, it’s a good idea to avoid staying in positions that feel uncomfortable. People often notice a link between recurring aches and pains, and sitting in a certain position for too long,’ says Dr McClymont  

Bad posture can cause pain in the neck, back, shoulders, legs and feet, as well as secondary pain in the head. On top of adding to stress and fatigue levels, poor posture can lead to more serious musculoskeletal conditions.

This is why it’s best to stay as active as possible, know how to improve your posture and look after your body.  

The NHS and the [British Chiropractic Association](https://chiropractic-uk.co.uk/posture/) have lots of free advice on how to correct your posture – which involves more than just sitting up straight! They also talk through exercises you can do to support your muscular health in everyday life.

## What are your postural muscles?

Postural muscles are also known as core stability muscles, and are found in your abdomen, pelvis and back. They act as natural scaffolding to stabilise and hold your body together. It’s very important to have strong and healthy postural muscles to help maintain good posture, coordination and balance.

‘Your postural muscles can only function properly if your body is correctly aligned,’ Dr McClymont explains. ‘Otherwise a vicious cycle of muscle weakness and poor posture may occur through injury or lack of use. In time, your core muscles will then start to become less efficient.’ 

## What causes poor posture?

There are many different reasons for poor posture – whether you’re relaxing at home, working or travelling around. Here are 6 of the most common.

### Slouching in a chair

Although this doesn’t always cause discomfort, slouching over time can put a lot of strain on your muscles and soft tissue. This can also increase tension in the muscles, and in turn, pain.   

### Sticking your bum out
If this is how you naturally stand or you have a noticeable curve in your lower back, you may have already been diagnosed with hyperlordosis. This is an exaggerated curvature of the lumbar spine, causing [lower back pain](https://www.livi.co.uk/your-health/what-can-help-my-lower-back-pain-a-doctors-tips/).

Carrying [excess weight around the stomach](https://www.livi.co.uk/your-health/is-your-waste-size-putting-your-health-at-risk/), pregnancy and wearing high heels can all contribute to this type of poor posture.

### Standing with a flat back
If your pelvis is tucked in and your lower back is straight instead of naturally curved, you will end up stooping forward. This can make it uncomfortable to stand for long periods of time.  

This type of posture is often caused by an imbalance in your muscles, or sitting down for too long. As this position can make you lean your neck and head forwards, it often causes neck and upper back pain.

### Leaning on one side
Lots of us will lean more on one leg – this standing posture is often more comfortable if you’ve been on your feet for a while. But instead of using your core muscles to hold your body upright, you’re applying added pressure on one side of your lower back and hip.

Over time, this can lead to muscle imbalances around the pelvis, and further strain to muscles in your lower back and buttocks.

Carrying heavy backpacks on one shoulder, or carrying a toddler on one hip, are other common causes of distributing weight unevenly.  

### A hunched back and angled chin
Most of us can be guilty of hunching over our laptop or computer keyboard from time to time, and this can be a sign that you have a tight chest or a weak upper back. If this sitting down posture is maintained for long periods of time, it can contribute to having a rounded upper back, as well as stiffness in the shoulders.

Using our smartphones can cause similar bad posture problems and neck pain like ‘text neck’. Poking your chin is another common posture mistake caused by having a hunched back, sitting too low at your desk, or having a computer screen set too high.

### Rounded shoulders
Having rounded shoulders are typically caused by poor posture habits, muscle imbalances or focusing too much on certain exercises, like chest strength (while neglecting the upper back). If you notice that you are falling into this posture regularly, it may indicate that you have a tight chest and a weak upper back.

## 6 ways to improve your posture 

‘Whether you’re mostly sitting or standing, there are quite a few simple ways to improve your posture day to day,’ reassures Dr McClymont. Here, she shares 6 of them to get you started. 

### 1. Stand tall
Perhaps the most obvious way to improve posture is by standing straight and tall as much as you can. Imagine a string is attached to the top of your head, near the back, and pulling you upwards. 

### 2. Make sitting properly a habit
Get into the habit of sitting correctly rather than slouching in chairs. It may not feel comfortable initially because your muscles are not conditioned to support you in the correct position, but when you're sitting down, make an effort to sit your bum back in your chair and push your shoulders back.

### 3. Check your desk setup
Try not to hunch over your desk, laptop or computer keyboard. Have a proper look at your work set-up, especially if you’re working from home. It’s really important to have an appropriately sized desk and chair, lined up correctly with the position of your computer, screen and keyboard. Find out [how to adjust your workstation](https://www.nhs.uk/live-well/healthy-body/how-to-sit-correctly/) to improve your posture at work.

### 4. Keep your shoulders back
When you’re sitting and standing, pull your shoulders back to avoid the strain on your back of having rounded shoulders. Simple exercises like the plank, bridges, pull-ups and chest stretches can help strengthen your core, upper back and chest muscles, and help correct rounded shoulders.

### 5. Balance your weight
Although it may not feel natural, stand with your weight equally distributed across both sides of your body, rather than mostly on one leg. Like anything, practise this regularly for it to feel more normal. 

### 6. Exercise
Introduce a few daily exercises to strengthen your core (postural muscles). Back extensions are one of the best exercises to correct posture. Yoga and pilates are another great form of exercise to improve core stability and strength, as well as [looking after your wellbeing](https://www.livi.co.uk/your-health/lockdown-20-a-doctors-wellbeing-tips/).

## How to help persistent bad posture problems

‘If you’re not able to get relief from posture exercises and your aches and pains persist, it’s a good idea to speak to your GP. You may be referred to a physiotherapist for further assessment and treatment, who can recommend exercises you can do at home to strengthen your postural muscles,’ says Dr McClymont.

You can also get more advice from a local chiropractor who will be able to make an assessment and help you start moving again without pain.

__This article has been medically approved by Dr Rhianna McClymont, Livi Lead GP.__


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Livi.co.uk > Your health > How to improve your posture – a doctor’s guide

How to improve your posture

Expert advice from a Livi doctor on improving posture

 How to improve your posture – and why it's important | Livi UK

How to improve your posture – a doctor’s guide

With summer approaching, it’s natural to start dreaming about picnics in the park and barbecues in the garden. But how much are you thinking about your hydration levels – and do you know how to notice the symptoms of dehydration? 

## Why is hydration important for my health? 

Our bodies need water for a whole host of essential functions. Water carries nutrients to the cells and transports the waste away, and it cushions and lubricates the brain and the joints. Through perspiration, it also helps to regulate the body’s temperature.

It means that dehydration, which is when the body loses more water than it takes in, can have an impact on almost every part of our body. 

Even mild dehydration can affect our ability to concentrate. It can lead to [headaches, extreme tiredness and constipation](https://onlinelibrary.wiley.com/doi/10.1111/j.1467-3010.2009.01795.x).  A lack of water can make the skin [dry, dull and itchy](https://pubmed.ncbi.nlm.nih.gov/29703638/).  There is even [some evidence  ](https://pubmed.ncbi.nlm.nih.gov/30395316/)to suggest it can impact the quality of our sleep.

## How much should I drink each day?

The answer depends on lots of factors – from your age to the weather to individual health conditions – and the advice is varied. In 2004, [the US Institute of Medicine of the National Academies](https://www.nationalacademies.org/news/2004/02/report-sets-dietary-intake-levels-for-water-salt-and-potassium-to-maintain-health-and-reduce-chronic-disease-risk)  recommended around 2.7 litres of water a day for women and 3.7 litres for men, while the [NHS’s Eatwell Guide](https://www.nhs.uk/live-well/eat-well/water-drinks-nutrition/) recommends you drink 6-8 glasses per day. 

## Which drinks count towards my intake?

‘While people tend to need about 3 litres of fluids a day, there are no hard and fast rules on how to achieve that,’ says Dr Samuel Menon, Lead GP at Livi.

‘It doesn’t always have to be through water that we measure out and carry around with us. Water also comes from the food we eat and other fluids we consume, from juices to tea and coffee.’

Dr Menon also recommends being mindful of your caffeine intake. As a diuretic, caffeine tricks the kidneys into releasing more urine than they should. 

## What’s the science behind hydration?

The body has a complex process for balancing fluid levels.

It closely monitors the osmolality, or the concentration of substances such as salt and potassium, in bodily fluids. When the concentration is too high, the body releases an antidiuretic hormone (ADH). This tells the kidneys to save water by reducing urination and tells the brain to stimulate thirst to make us drink. Similarly, when the concentration is too low, the kidneys prompt urination.

‘Healthy kidneys will do most of the adjusting that’s necessary to keep our bodies hydrated,’ says Dr Menon. ‘Drinking a reasonable amount of fluid to allow your kidneys to get this right – not so little that you’re thirsty and not so much that you’re peeing all the time – is all that’s required in a healthy individual.’ 

## Can you drink too much water?

It is possible to drink too much, but if you’re otherwise healthy, it’s usually harmless. In most cases overhydration will just lead to additional trips to the toilet.

## How do I know if I’m dehydrated?

Thirst is the best rule-of-thumb symptom in day-to-day life, says Dr Menon. The other common signs and symptoms of mild to moderate dehydration are:
- A dry or sticky mouth
- Urinating less often
- Feeling lightheaded
- A headache
- Dark urine

This urine chart is a good reference and illustrates what the colour of your pee may mean:

![Why is hydration so important? A doctor’s guide](//images.ctfassets.net/h8qzhh7m9m8u/cFxiuDXrtVv1dAoJW9kfl/6fce6d90fa6e4b9100067154298b93dd/NEW_Urinechart.png)

Severe dehydration can be very serious. The signs include:
- Extreme thirst
- Dry skin
- Sunken eyes
- A very low urinary output
- A dehydrated tongue that feels dry and sticky
- Delirium 

## What are the symptoms of dehydration in children?

It can be more difficult to spot dehydration in children and babies than in adults, because they don’t tend to display the [symptoms of mild dehydration](https://www.ncbi.nlm.nih.gov/books/NBK436022/).  When they’re moderately dehydrated, they may:

- Be listless or irritable
- Have a high heart rate
- Breathe very quickly 
- Have sunken eyes
- Urinate less than usual

Babies may also have a sunken fontanelle, or soft spot at the front of the head, when dehydrated.

## What makes someone more susceptible to dehydration?

Lots of things can affect the likelihood of dehydration, says Dr Menon, including our lifestyle and environment. 

People should make sure they replace lost fluids through sweating while exercising or in hot, dry weather, for example.

‘When we’re unwell, we can lose more fluids than normal from our skin, lungs or gut because of fever, vomiting or diarrhoea,’ says Dr Menon.

What’s more, some long-term health conditions, like heart or kidney diseases, can affect the way our body manages the balance of fluids. This can make people more susceptible to dehydration. 

## What is alcohol dehydration? 

Many people will crave water the morning after drinking alcohol. That is because, just like caffeine, alcohol inhibits the release of ADH, the hormone responsible for telling the kidneys to conserve water.

‘Having less ADH results in us losing more water in our urine,’ says Dr Menon, ‘If you’re drinking espressos by day and martinis by night, dehydration is inevitable.’

## Are there any long-term effects of dehydration?

Mild to moderate dehydration is reversible and doesn’t have any lasting effects.

Chronic or long-term dehydration however, can increase the risk of infections. This is especially true of [urinary tract infections](https://www.livi.co.uk/your-health/utis-your-questions-answered/). Severe dehydration[ can damage the kidneys and even lead to kidney failure](https://www.europeanhydrationinstitute.org/consequences_of_dehydration/). 

## When should I speak to a doctor?

Severe dehydration can be dangerous. Red flags to look out for in yourself or others might include reduced responsiveness, sunken eyes, a fast heartbeat and rapid breathing. 

In most cases, though, mild to moderate dehydration is nothing to worry about. Drinking more fluids will reverse the symptoms and your body will carry on working to keep your fluid levels balanced.

__This article has been medically reviewed by Dr Samuel Menon, Lead GP at Livi__


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Speak to a GP about dehydration

Livi.co.uk > Your health > Why is hydration so important? A doctor’s guide 

Why is hydration so important? A doctor’s guide 

Dr Samuel Menon, Lead GP at Livi, shares his advice for keeping hydrated and healthy this summer – and explains how to spot the key signs of dehydration

Why is hydration so important? A doctor’s guide | Livi UK

A good night’s sleep helps you wake feeling refreshed and ready for the day, and there is compelling evidence to show it’s also important for your overall health and a strong immune system.   

Most adults need 6-9 hours’ sleep a night  and as we sleep, our body carries out all sorts of running repairs and essential maintenance. That may explain why long-term sleep problems are linked to an increased risk of obesity, diabetes, heart disease, cancer, depression and other serious health problems. 

Before the pandemic, about a third of adults suffered regular episodes of insomnia    and studies from around the world have found this has worsened as a result of anxiety and [sleep disruption related to Covid-19](https://www.livi.co.uk/your-health/4-ways-to-sleep-better-during-the-pandemic/). 

Here are some common sleep problems and our advice for getting help.

## 1.	Insomnia 

There are generally 3 types — struggling to get to sleep, being easily disturbed and waking up in the night, or waking too early. But Livi GP Dr Rhianna McClymont says simple lifestyle changes and improved sleep habits should resolve most of these issues. 

‘It’s important to have a sleep routine, which ideally includes going to bed at the same time each day, making sure your bedroom is dark and quiet, and avoiding electronics before bed,’ she says.

Your bedroom should be a place reserved for sleep, and for sex, as this is the only form of physical activity which makes us sleepy.  Other tips to help you unwind and switch off include: 

- Avoid caffeinated drinks for 6 hours before bedtime  
- Have a warm, milky drink or herbal tea as you wind down
- Keep the temperature in your bedroom between 18C and 24C
- Fit thick curtains, or use an eye mask so you’re not disturbed by light
- Use earplugs if your partner snores, or you live in a noisy neighbourhood
- Take a warm, but not hot, bath just before bedtime
- Get regular exercise, a sedentary lifestyle increases the risk of insomnia  
- Avoid vigorous exercise 4 hours before bedtime, but yoga stretches and relaxation exercise can be helpful
- Write a to-do list to try to clear your mind of distractions
- Sprinkle a few drops of lavender oil into a diffuser or on your bedding, as studies suggest it can help to improve sleep quality

If you’ve tried to improve your sleep hygiene and insomnia is continuing to affect your daily life, keep a sleep diary for 2 weeks and then discuss the results with a GP. 

‘Sleeping tablets are not normally recommended as they can be addictive and disrupt your natural sleep pattern,’ says Dr McClymont. But your doctor may recommend a sleep app or suggest Cognitive Behavioural Therapy (CBT) to tackle the thoughts and habits that keep you awake at night. 

## 2. Sleep apnoea (OSA)

Sometimes called Obstructive Sleep Apnoea (OSA), this common sleep condition is linked with an increased risk of heart attack, stroke and road accidents. 

But many people who have OSA don’t realise they have a problem. For instance, it’s estimated that around 1.5 million adults in the UK have OSA but only 330,000 cases have been diagnosed .

Symptoms of OSA may initially only be noticed by partners — they include the following:

- Stop-start breathing
- Loud snoring
- Gasping for breath, or making snorting or choking noises
- Waking frequently during the night
- Feeling very tired during the day
- Waking with a headache
- Poor concentration
- Mood swings

‘If you have symptoms of sleep apnoea and it’s affecting your activities — for instance, you fall asleep while sitting and reading, or while a passenger in a car — then you should talk to a GP,’ says Dr McClymont.

‘Weight loss or reducing your alcohol intake can improve sleep apnoea. If these measures don’t help, your GP may refer you to a specialist who can offer further treatment such as CPAP,’ she says. This is a mask device which delivers oxygen via Continuous Positive Airway Pressure (CPAP). It’s worn while you sleep and is a very effective treatment for sleep apnoea.

## 3. Sleep paralysis 

Feeling you’re awake but unable to move or speak is known as sleep paralysis and is most likely to happen as you are waking up or just as you’re falling asleep. It can last for a few seconds or even a few minutes and, while this can be frightening, it’s usually nothing to worry about.  

‘Sleep paralysis does not usually need treatment, but if it is occurring very regularly, or is distressing you, have a chat with a GP,’ says Dr McClymont.

‘Sleep paralysis has been linked with [generalised anxiety disorder (GAD)](https://www.livi.co.uk/your-health/need-help-for-anxiety-here-are-your-questions-answered/), panic disorders and PTSD. If this seems to be the cause for you then a doctor can arrange for psychological treatments to address these.’

## 4. Restless legs syndrome 

If you get an overwhelming urge to move your legs at night, you may have restless legs syndrome, which is also associated with jerking movements or an unpleasant creeping sensation. 

There’s often no obvious cause, although it can run in families and is more common during pregnancy. It’s estimated that 1 in 5 women experiences restless legs syndrome during pregnancy. 

‘It can generally be improved with regular exercise, leg massage and a good sleep routine,’ says Dr McClymont. ‘But if this doesn’t relieve symptoms or you find the symptoms upsetting, it’s a good idea to see a doctor.’

Restless leg syndrome can be a sign of iron deficiency or kidney problems and, if your symptoms are severe, there are also prescription medications that may be considered. 

## 5. Night terrors 

These are common in children aged between 3 and 8. And while they are frightening, children rarely remember them the next morning and they don’t cause any long-term psychological harm.  

Episodes usually occur early in sleep and are more likely when children are overtired or feverish. The child may shout, scream and thrash around in sheer panic. Their eyes may be open, but they are not actually awake.

Unless your child is in danger of hurting themselves, it’s best not to wake them. But if the episodes happen around the same time, you can try waking them 15 minutes earlier, every night for a week, to try to break the cycle.

If the night terrors persist, or occur several times a night, speak to your GP as there might be an underlying issue which can be treated — such as a breathing problem caused by oversized tonsils.


livi.co.uk > Your health > 5 sleep problems to discuss with a doctor

 5 sleep problems to discuss with a doctor

Sleep is essential to a strong immune system, stable mood, weight management and cognitive functioning. If you’re not getting enough, or your life is affected by other problems such as daytime sleepiness, it may be time to get help 

5 sleep problems to discuss with a doctor | Livi

Reviewer > Dr Rhianna

IMG 20200730 224911 865[33] (1)

Dr Rhianna McClymont

Lead GP at Livi

## Quick facts

- Headaches can be a key sign of high blood pressure
- Hormonal headaches or migraines are common in women
- Caffeine withdrawal or the overuse of painkillers can also be causes

If you suffer with regular headaches, you’re not alone. Around 50%-75% of us will have had a headache at least once in the past year.  Most headaches are nothing to worry about, and once you’ve identified their types and triggers, it’s usually easy to prevent or treat them at home.  ‘But always speak with a doctor if your headaches don’t improve, if you’re worried and want more information, or if your headaches are so severe they’re interfering with your daily life,’ says Dr Rhianna McClymont, Lead GP at Livi.

Here’s a guide to the common types of headaches and what you can do about them.

## 1.	Tension headache

__How it feels__
You’ll have a mild to moderate pain on both sides of your head  and the muscles in your neck may also feel tight, possibly with pressure behind your eyes.  

__What causes tension headaches?__
Stress, poor posture, squinting, screen overuse, tiredness, dehydration, missing meals, lack of physical activity, bright sunlight, noise and certain smells. 

__What you can do__
‘Tension headaches are usually relieved by over-the-counter painkillers,’ says Dr McClymont. ‘But, making lifestyle changes can help to prevent them. Anything that reduces stress such as yoga, meditation, massage or exercise can help.’ Make sure you take screen breaks, eat regularly and drink plenty of water throughout the day too. 

The National Institute of Health and Care Excellence (NICE) recommends that a course of up to 10 sessions of acupuncture over a 5-8 week period may be beneficial in reducing chronic, tension-type headaches.  

## 2. Cluster headache

__How it feels__
These come on suddenly and the pain is severe, usually a sharp, piercing or burning sensation on one side of your head.  Cluster headaches are more common in men. The pain is often felt around your eye, temple, and sometimes the face. There may be one or more other symptoms too like a red, watering eye, drooping or swelling of one eyelid, a smaller pupil in one eye, a sweaty face or a blocked or runny nostril.  Attacks generally last 15 minutes to 3 hours, and can occur in daily bouts lasting from 4-12 weeks.

__What causes cluster headaches?__
It’s not known but   there may be a genetic factor and smokers are more at risk. Attacks may be triggered by alcohol and strong smells such as perfume, paint or petrol. 

__What you can do__
‘Always talk to a doctor if you think you’re experiencing cluster headaches,’ says Dr McClymont. ‘These often require specialist treatment with a neurologist.’  

## 3. Migraine

__How it feels__
Migraine affects 1 in 5 women and 1 in 15 men  with the main symptom being a moderate or severe throbbing headache. They can also come with other symptoms like feeling sick and vomiting, disturbed vision, sensitivity to light, sound and smells. You may see flashing lights before it begins (migraine with aura) but, most commonly there are no warning signs. A silent migraine is where you see flashing lights and have other symptoms but no headache. Attacks may last from 4-72 hours.  

__What causes migraines?__
Some people are genetically predisposed to migraines. It’s thought that migraines may be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.  Possible triggers include: 
• emotional (for example, stress, anxiety, tension) 
• physical (for example, tiredness, neck and shoulder tension or low blood sugar) 
• dietary (for example, alcohol, dehydration or certain foods containing the compound tyramine, which is found in cured meats, smoked fish and strong and aged cheeses) 
• hormonal and environmental (for example, bright lights, sounds, smells) 
• certain medications (like hormone replacement therapy and the combined contraceptive pill). 

__What you can do__
‘You should see a doctor if your migraines are severe or occurring frequently,’ says Dr McClymont. ‘There are various prescription treatments available for migraines that can help to alleviate symptoms or try to prevent them.’ Identifying and avoiding your triggers is also important.

## 4. Sinus headache

__How it feels__
You’ll be feeling pressure or throbbing around your cheeks, eyes and forehead and may also have facial pain.

__What causes sinus headaches?__
These are usually caused by sinusitis, a swelling of the sinuses, usually caused by infection.  Other symptoms include a blocked or runny nose, reduced smell, fever, toothache, green or yellow mucus from your nose.

__What you can do__
‘Sinus headaches can generally be alleviated by self-care like getting plenty of rest, inhaling steam, taking painkillers and drinking lots of fluid,’ says Dr McClymont. ‘But, see a doctor if your headache has persisted for over 3 weeks as there are prescription medications that may help.’

## 5. Rebound headache

__How it feels__
You may feel anything from a dull tension-like headache to more severe pain.

__What causes rebound headaches?__
These are also known as medication overuse headaches and can happen when people regularly over-use painkillers, most commonly over-the-counter analgesics.  The theory is that as the level of the drug in the blood stream begins to wear off, the headache suppressed by the medication ‘rebounds’. What’s more, as medication becomes less effective the more you use it, pain-free periods become shorter and headaches rebound with increasing frequency. 

__What you can do__
Stress reduction and making lifestyle changes to stop headaches can help. But you will need to stop the pain medication. If you need support to do this or help deciding if this is the cause of your headaches, talk to a Livi doctor.  

## 6. Caffeine withdrawal

__How it feels__
You have an intense, throbbing, painful headache and may also feel irritable, anxious and nauseous.

__Causes__
If you regularly drink coffee, tea and other caffeinated drinks and then stop, you may get symptoms of caffeine withdrawal, including headaches. This is because caffeine constricts blood vessels and when you stop these widen, increasing blood flow which can trigger headaches. Other symptoms of caffeine withdrawal include anxiety, irritability, nausea and muscle aches.

__What you can do__
These usually subside over a couple of days as the brain adapts to the change in blood flow as a result of less caffeine.  If you want to reduce or give up caffeine and avoid headaches, cut down slowly over a period of 6 weeks instead of stopping it abruptly.   

## 7. Hormonal headache

__How it feels__
You may get moderate to severe headaches or migraines at certain times in your cycle.

__Causes__
Many women get headaches that are caused by changes to their hormones.  Menstrual migraines, for example, may occur a few days before and during your period, due to the drop in oestrogen. The hormonal changes that occur as you approach menopause or in the first few weeks of pregnancy can also trigger headaches. 

__What you can do__
Keep a diary to help you track your headaches and where they occur in your cycle, for example before a period. Lifestyle changes such as keeping blood sugar levels balanced with regular meals containing healthy proteins and complex carbohydrates, stress reduction and regular exercise can all help to balance hormones.  Always talk to your doctor if you think any hormone medication like the contraceptive pill is making things worse.

## 8. Hypertension headache

__How it feels__
You usually feel a pulsing, throbbing pain on both sides of the head. 

__What causes hypertension?__
Most people are unaware that they have high blood pressure, because they have no obvious symptoms. But headaches can be a sign of high blood pressure. There may also be other symptoms like nausea, vomiting, fatigue, confusion and nosebleeds. The ideal blood pressure is considered to be between 90/60 mmHg to 120/80 mmHg.  Anything above 140/90 mmHg is considered too high and can be a contributing factor to heart disease and stroke risk.

__What you can do__
‘A hypertension headache needs treatment for the underlying high blood pressure,’ says Dr McClymont. Lifestyle changes such as weight loss, moderate exercise, reducing stress levels and improving your diet can all help. But if blood pressure is too high your doctor will prescribe medication.  Talk to a doctor if you think you’re getting hypertension headaches.

## 9. Exertional headache

__How it feels__
You’ll feel moderate to severe throbbing pain that starts during or after strenuous exercise.

__What causes exertional headaches?__
Forms of exertion that may trigger these headaches include running, bending and lifting as well as coughing, sneezing and even having sex.  

__What you can do__
‘A new exertional headache may, in some cases, be a sign of an underlying problem in the brain,’ says Dr McClymont. ‘So, if you start experiencing exertional headaches, particularly if you have never had them before, see a doctor for an examination.’

## Are there any types of headache to worry about?

Dr McClymont advises that you always consult a doctor:

- For any new headache that has been persistently present for a few weeks without improvement, or that is severe and interfering with your daily life
- If you have a headache that wakes you in the middle of the night, gets worse when you’re lying down, makes you vomit, or occurs when you’re coughing or straining

You should seek emergency care for:

- A sudden headache that is accompanied by neurological problems (like weakness in your arm or leg or double vision), or by signs of infection (like a very high temperature with a new rash)
- A very sudden, extremely severe headache (often described as a ‘thunderclap’), as a sudden bleed in the brain can cause this type of headache


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9 types of headache and what you can do

What type of headache do I have? 9 types of headache and how to help

Most of us know instinctively that taking a deep breath can make us feel better in a tricky emotional moment. And in wellness disciplines like yoga and mindfulness, controlling the breath plays a key role in calming the mind. 

Now, science is catching up. Research has shown that controlled breathing exercises — as well as having physiological benefits for respiratory and cardiovascular health  — can help to reduce symptoms of stress,  anxiety  and depression.  A recent review found that slow breathing can also enhance relaxation and psychological wellbeing.  

‘Breathing practice is so important when you’re working with mood and wellbeing,’ says Dag Härdfeldt, Psychologist at Livi. ‘Simply adjusting the way you breathe can affect your nervous system and influence your emotional response. 

‘If you’re feeling stressed or anxious, for example, your breathing is probably more shallow which can stimulate the sympathetic nervous system and trigger the “fight or flight” stress response. But if you breathe in a slow, controlled way – preferably using your diaphragm, you can activate the parasympathetic nervous system, which induces feelings of calm and relaxation.’ 

Anyone can learn how to use breathing exercises to enhance their physical and mental health. Here’s a simple guide to the basic principles of controlled breathing and 3 specific techniques to get you started.

## How to use your breath to feel better

‘There are lots of different breathing exercises and techniques you can use,’ says Härdfeldt. ‘I would encourage anyone to seek out the ones that suit them best. But, for any breathing practice to be effective, there are key concepts to bear in mind.’

__Breathe to a rhythm__
Control is important during breathing practice. It should follow a certain rhythm, like a beat. It may be helpful to count as you inhale and exhale.

__Be mindful__
This means focusing on what you’re doing. Try not to think of anything else and really experience the airflow as you inhale and exhale. Mindfulness may take practice and it’s more beneficial to do a breathing technique for a shorter length of time, when you are completely in the moment, than for longer periods without focus.

__Always use your diaphragm__
When you’re doing a breathing exercise, breathe deeply with the help of your diaphragm (this is the large muscle at the base of your ribcage — if you hold your sides gently, you will feel it expand sideways as you inhale and contract as you exhale). Hold the breath there for a while (about a second or 2) to maximise oxygen intake before releasing it. Studies show that diaphragmatic breathing triggers relaxation responses that benefit both physical and mental health. 

## 3 breathing techniques to help you manage your mood

Härdfeldt recommends the following breathing techniques and exercises to help manage your mental and physical health.

#### 1.	Diaphragmatic breathing 
__Helpful for — [anxiety](https://www.livi.co.uk/your-health/need-help-for-anxiety-here-are-your-questions-answered/), stress, panic or depression__

‘If you suffer from anxiety, depression or stress, you might need to retrain how you breathe,’ says Härdfeldt. ‘When you’re anxious or stressed, breathing becomes faster and more shallow, which can interfere with the balance of oxygen and carbon dioxide and this can trigger even more anxiety, fear and panic.  It’s similar with depression: you may feel broken, sad and tired and this affects your breathing. Your body is receiving signals that something is wrong, which may make you feel worse.

‘Diaphragmatic breathing can help break this cycle by activating the parasympathetic nervous system, which instantly triggers a calming response and helps to alleviate the symptoms of anxiety, stress and depression.  But it takes practice and ideally, you need to do it daily for 2-3 months, before you start to breathe like this more naturally rather than just taking air into your chest.’

__How to practice diaphragmatic deep breathing__
- Lie on your back with your knees bent. Use a pillow, if this feels more comfortable
- Place 1 hand on your upper stomach, just above the diaphragm, where the rib cage ends
- Place the other hand in the middle of your upper chest
- Slowly inhale through the nose and focus on drawing the air right down towards your diaphragm and abdominal muscles
- Your stomach should push against your hand as you breathe in and your chest should remain still.  This takes some practice
- To exhale, let your stomach fall downwards as you breathe out through your nose
- Practise this exercise daily for 2-3 minutes, gradually increasing this to 5-10 minutes, or more, after a couple of weeks

#### 2.	Pursed-lips breathing 
__Helpful for — anxiety and some respiratory conditions__

Pursed-lips breathing (PLB) is a technique that helps you to breathe more slowly, deeply and effectively with less effort. PLB is very beneficial for people with COPD and other respiratory conditions, such as asthma.  But, it’s also very effective for anxiety. 

__How to practise pursed-lips breathing__
- Sit with your back straight or lie down
- Inhale through your nose for 2 seconds. Really draw the air down into your abdomen
- Purse your lips and breathe out slowly, for 4 seconds. You should take twice as long to breathe out as you breathe in. Over time, you can increase the inhale and exhale counts (for example, to 4 and 8 seconds)
- Repeat for 1-10 minutes

#### 3.	Alternate nostril breathing
__Helpful for — anxiety, stress, insomnia and focus__

Alternate nostril breathing (ANB) is a yogic breathing technique that can be useful in calming the mind, says Härdfeldt. ‘It helps to activate the sympathetic and parasympathetic nervous systems equally, which helps to balance active and restful states.’ One study reported that 15 minutes of ANB can help to lower anxiety in a stressful situation. 

- Sitting comfortably, close your eyes and gently place your ring finger on your left nostril and your right thumb onto your right nostril
- Close your right nostril with your right thumb and inhale slowly and deeply through your left nostril
- Close your left nostril with your ring finger, and open your right nostril. Exhale through your right nostril 
- Inhale through your right nostril. Close your right nostril with your thumb and exhale through your left nostril 
- This completes one round
- Repeat for 5-15 minutes, or as long as feels comfortable
- If you’re left-handed, use the same directions with your left hand

Need more help? Read more about the [daily tools that can help depression](https://www.livi.co.uk/your-health/help-for-depression-7-daily-tools-to-improve-your-mood/).

#### How Livi can help

If you’ve been suffering with anxiety or low mood for 2 weeks or more, you can talk to a Livi doctor who can suggest a plan to help improve your mood and wellbeing.

__This article has been approved by Dag Härdfeldt, Psychologist at Livi.__


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Breathing exercises

Your breath is a simple tool you have anytime to help feelings of anxiety, depression or stress. Dag Härdfeldt, Psychologist at Livi, shares the techniques he teaches patients to help manage moods

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Top breathing exercises a psychologist recommends | Livi UK

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3 breathing exercises a psychologist recommends

Just as our bodies age, our brains age too. As we get older, the areas of the brain that control emotional expression, problem-solving, attention and mental abilities start to get smaller.

Research shows that the overall volume of the average brain shrinks by around 5% each decade after the age of 40, with the rate of decline increasing after 70. These changes can make you increasingly susceptible to cognitive dysfunctions like memory loss, impaired thinking and dementia.

In fact, around 50 million people worldwide have dementia, according to the World Health Organization (WHO). In the UK, there are 850,000 people with dementia, and this is projected to rise to 1.6 million by 2040.

While these statistics may sound scary, there’s no cause for alarm. Evidence shows there are plenty of things you can do to help prevent cognitive decline.

### 1. Do 30 minutes’ aerobic exercise 4 to 5 times a week

People who are physically active are less likely to develop cognitive decline. Exercise improves blood flow and oxygen supply and this stimulates chemical changes in the brain that enhance cognitive function. One study found that doing aerobic exercise in particular, for half an hour, 4 to 5 times a week, could help to slow shrinking of the hippocampus, the part of the brain that deals with memory. [Exercising regularly](https://www.livi.co.uk/your-health/how-to-fit-exercise-into-your-daily-life/) also reduces your risk of developing high blood pressure, heart disease and stroke, all of which can have an adverse effect on brain health.

### 2. Eat a MIND diet

The MIND diet consists of eating plenty of wholegrains such as quinoa, oats and barley; plenty of leafy greens; brightly coloured vegetables; nuts; berries, especially strawberries and blueberries; beans, lentils and soybeans; poultry and oily fish at least once a week, and cooking with olive oil. It also suggests avoiding or minimising red meat, processed food, salt, cheese and butter, and sugar. Get tips on [how to make healthier food choices](https://www.livi.co.uk/your-health/8-ways-to-make-healthier-food-choices-every-day/).

### 3. Get musical

Learning to play a musical instrument may enhance brain function as we get older, and could also help prevent age-related cognitive problems — according to a systematic review of scientific research. But if you’re no Mozart, don’t despair. Just listening to music you enjoy is also beneficial for healthy brain function as research shows it can help memory and reasoning.

Learning new dance moves may help support your brain health too. Dancing reduces stress, increases levels of feel-good endorphins and also helps develop new neural connections, especially in those parts of the brain involved in executive function, long-term memory and spatial recognition.

### 4. Stay socially connected

Being [socially engaged and supporting others](https://www.livi.co.uk/your-health/supporting-others-during-difficult-times/) is important for a healthy brain. When you interact with others, whether it’s spending time with friends, volunteering or having a chat with a neighbour, parts of your brain are stimulated. Research shows that just one hour a week of social interaction is beneficial for people with dementia.

### 5. Meditate

Meditation has many benefits. It can help to calm the mind, reduce stress and lower blood pressure. Research also shows it may help reduce age-related memory loss — and benefits can be seen in as little as 12 minutes a day of regular meditation.

### 6. Reduce your stress levels

Stress can be a contributing factor for many health problems, including heart disease, insomnia and anxiety disorders. Research also shows that higher blood levels of the stress hormone cortisol are associated with memory impairment and reduced brain size in middle-aged adults. So, if your [stress levels are high](https://www.livi.co.uk/your-health/physical-signs-of-stress-on-the-body/), protect your brain by finding ways to manage your stress better, such as yoga or meditation.

__Reviewed by: Rhianna McClymont, Lead GP, Livi__


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