“If all else fails there’s always Tolstoy’s ‘War and Peace.’ Sometimes just looking at such a massive book makes you tired enough to sleep.”

Since a good night’s rest is the cornerstone of optimal health and even positivity, I thought I’d offer up some suggestions for holiday gifts that an insomniac would really appreciate.

1. Consider trying a soundtrack from Pzizz (left), which calls itself “your personal sleep and relaxation assistant.” The tracks are different every time you listen to it and you can control how long to let the audio play. Export a program to your smartphone or IPod and keep it by your bed at night. It can help you decompress on business trips too.

2. If a short late afternoon nap is all you need, consider the Power Nap Kit from At Peace Media. It features three voice-guided power-nap sessions (disc 1) and three music-only power nap sessions (disc 2).  The kit includes a 44-page booklet about sleep, stress and power naps. It just might be the tool you need to help relax and rejuvenate you.

3. The Nightwave Assistant might work for you too. It’s a small appliance (the size of a cell phone) that projects a soft, changing blue light on the ceiling of your darkened room. By synchronizing  your breathing with the light, your body and mind are supposed to fall into a state of relaxation that promotes sleep. It’s worth a try if you’re sleep deprived. If it works, it’s small enough to travel with.

4. Alternatively, have you tried aromatherapy?  21drops, a line of blended essential oils, claims their Sleep product (#18) will calm a racing mind and settle your restlessness so you can get a good night’s rest. You apply it to your temples, wrists and back of neck and even under your nose.

5. Another prescription-free approach to better sleep can be found in The Republic of Tea’s “Be Well” line of red, caffein-free teas.  Their “Get some ZZZs” (#5) is an herbal blend of sleep-promoting Rooibos, Chamomile, Passionflower and Valerian. You’ll also find it in their Sleepytime Gift Set, which also includes pillow spray, an eye mask and ear plugs.

6. Perhaps relaxing music is more your thing. Dr. Machelle Seibel’s Healthrock series of music CDs includes “Sleep Tight,”  featuring 46 minutes of soothing, peaceful music that can make falling asleep easier. Dr. Seibel, who is director of the Complicated Menopause Clinic at the University of Mass., composed the music himself with his sleep-deprived menopausal patients in mind.  You can preview the music and then download the album, or order the CD directly from his website.  Also, check out his “Relax” CD featuring instrumental music that he also composed and performed, to help you wind down in the evenings after a hectic day.

7. If hot flashes are keeping you from getting a restful sleep, consider trying a new comforter this winter. Mulberry West makes silk-filled, cotton comforters that they claim offers a lightweight “veil of warmth.” As explained on their website, silk is a porous and natural fiber, which adjusts to temperature fluctuations and is known for strong ventilations.  If you’re throwing off covers every night, this might be a good solution for you (and your partner).

8. Meditation, even for 5-10 minutes a day, can have a profound effect on stress reduction and sleep quality.  If one of your new year resolutions includes a commitment to carving out more time for yourself, I highly recommend Dr. Joan Borysenko’s The Beginner’s Guide to Meditation, or her more recent Stress Less CD featuring two meditations created to “help reduce stress, improve sleep and create optimal health and energy.”  Dr. Borysenko, a pioneer in mind-body medicine and the author of 14 books, will be leading a weekend program beginning Jan 27th at the Kripalu Center for Yoga and Health in the beautiful Berkshire Mountains in Western Massachusetts. In addition….

9.The Kripalu center will hold a four-day workshop, beginning New Year’s day, on Gentle Yoga and Mindful Eating. Both of these programs are a fabulous way to help you start the year on the right foot. I’ve been to Kripalu and can tell you that the view of the surrounding hills and lake are worth the trip alone – even in winter.

10. If all else fails there’s always the latest edition of War and Peace, Tolstoy’s 1440-page epic novel with a new English translation that makes it a bit easier to get through. Sometimes just looking at such a massive book makes you tired enough to sleep.

I often receive emails from these women. They tell me about their health problems and severe menopause symptoms that have converged to make them miserable and they’re desperate for answers. They found this blog in an online search while trying to self-diagnose and self-prescribe with over-the-counter medicines, supplements or herbal remedies that they really don’t know anything about.  Some of their stories are truly heart-breaking because I know that a caring doctor or nurse practitioner could help them feel better.  If only they could find one.

If this sounds like your situation, here’s a tip. The solution just might be found at your local hospital, especially if you live near a major medical center, as I do here in San Francisco.

I just received the Fall newsletter from the Women’s Health Resource Center of  California Pacific Medical Center. and it reminded me about the many resources a community hospital can offer women.  In addition to a wide range of classes, special programs and even therapeutic massages, private consultations with a nurse practitioner about Osteopororis (including screening), managing Menopause, eating disorders, nutrition and mental health are available.  Meeting one-on-one with the center’s founder, Barb Silver, a nurse practitioner, cost $30 for each half hour (considerably less than a physician’s bill for a 10 minute appointment).  And from time to time she offers a women’s health “roundtable” where women can get their questions answered.  It costs only $5 and it’s a great way to get an overview of a health topic you’re interested in as well as meet other women who share the same interests or concerns.

“I love the intimacy of getting women together and having their individual concerns addressed,” said Barb. “Most likely, many women share the same questions, fears and anxieties about their health issues. It gives me an opportunity to really hear their voice, whether it is during a one-to-one consult or a roundtable.”

If you do live in the Bay area, be sure to sign up for their annual Mini Medical School on Women’s Health on Saturday, Oct. 22.  Distinguished local physicians will be speaking on a wide range of topics that you’ll find relevant and helpful. This one-day program is open to the public but pre-registration is required.  You’ll find more details on their website.

California Pacific Medical Center has other departments that serve the needs of Bay area women of all ages including the Comprehensive Pelvic Medicine and Continence Center,  and the Breast Health Center. Chances are the medical center near you has similar capabilities that you can take advantage of.

If there’s a Women’s Health Center or Menopause Clinic at a medical center near where you live,  I invite you to share their information with other women in the comment box below.

Chromium - This mineral is at the top of her list of “mighty minerals.”  ”It’s vital to keep blood sugar in balance, but it is not present in refined foods,” she writes. “It plays a major role in weight control because it helps to control cravings and reduces hunger. It has also been shown to reduce levels of the stress hormone cortisol.”

Magnesium - Known as “nature’s tranquilizer,” it calms the adrenal glands and helps to balance blood sugar by contributing to the production and action of insulin. “It’s also important for its involvement in energy production, bone health, blood clotting, muscle relaxation and regulating heart rhythm,” she explains. Dr. Glenville suggests taking magnesium citrate rather than the cheaper magnesium oxide because it’s easier to absorb.

Green Tea Extract - Green tea contains many compounds including catechins, which Dr. Glenville writes has been shown to help burn off fat and also inhibit growth of cancer cells.  Green tea also contains an amino acid called L-theanine that has a relaxing effect on the brain and body.

So, to find out what you can do to reduce your risk of stroke, start by reading the April issue of Consumer Reports onHealth Newsletter , which devoted its cover story to new guidelines from the American Heart Association and the American Stroke Association for preventing a first stroke. As they explain, controlling your blood pressure and keeping your LDL cholesterol in a healthful range, through lifestyle changes and/or medication, can reduce your risks by a third.  I asked Dr. Orly Avitzur, a board-certified neurologist and medical advisor for Consumer Reports Health, how diet also influences our risk of stroke:

Dr. Avitzur: Studies have shown that diet does matter when it comes to your risk of strokes. One study demonstrated that each extra daily serving of fruit or vegetables reduced the risk of stroke by 6 percent.  Other research has linked sodium rich diets to a greater risk of stroke, and high potassium diets to a lower risk of stroke.  One diet that has been shown to work in reducing high blood pressure–one of the greatest risk factors for stroke–is the DASH diet (dietary approaches to stop hypertension).  It’s a 2,000 calorie a day diet that suggests 7-8 servings of grains, 4-5 servings of fruits, 4-5 servings of vegetables, 2-3 servings of low-fat dairy products, and 2 or fewer servings of lean meats. Snacks and sweets are limited to 5 per week. Although it does not restrict salt, combining it with a salt-restricted diet can improve blood pressure lowering. Though it can be tough, try to consume no more than 1500 mg of sodium–roughly two thirds a tsp of table salt a day, the maximum recommended by the AHA. (Most Americans go quite a bit over this amount).

A long-term study of 88,000 middle aged women, who followed these diet guidelines showed that their risk was reduced by 18 percent compared to those who did not.  That’s a substantial reduction, and one any one can achieve.  We can’t do much about our family histories but we can control our diets and make a real difference in our health!

Wendy: How does our BMI (Body Mass Index), and belly fat in particular, increases our risk of stroke?

Dr. Avitzur: Most women are concerned about belly fat, but for all the wrong reasons.  While appearance is one thing, your health is even more important.  And that extra fat around your middle can raise your risk of dying early if you have heart disease, even if you’re at your normal weight.  Research has shown that people with extra belly fat (as measured by waist-to-hip ratio) are nearly twice as likely to die as those with normal waistlines.  In fact, the risk is similar to that of smoking a pack of cigarettes a day!  Even people with normal body mass index (BMI) are at greater risk if they carry extra weight around their abdomen. So if you look at your middle and don’t like what you see, speak with your doctor about this risk and how you can whittle it down.

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Here are some additional resources where you can read more about cardiovascular health:

National Stroke Association- Unique Symptoms in Women

Everyday Health: How Do Strokes Affect Women?

WomensHealth.gov- Frequently Asked Questions

ABC News: Strokes HIt Women Harder

• Total Cholesterol: <200 mg/dL
• LDL (“bad”) cholesterol:  <100mg/dL
• HDL (“good”) cholesterol: 50mg/dL or higher
• Triglycerides:  <150mg/dL
• Fasting Glucose <100mg/dL

The AHA offers many helpful tools, from online trackers to healthy diet tips, to help you learn about and monitor your heart health.  When you sign up for their “Go Red for Women” program, you can take a “heart check up” to assess your cardiovascular health factors, and receive a free 12-week online nutrition and fitness program and coaching tools.

If it’s an occasional problem that doesn’t interfere with your life, your physician will probably recommend pelvic floor muscle training, also known as Kegel exercises. Many women have trouble isolating the proper muscles needed to perform the exercises correctly but, as with every other problem, there’s an app for that.

Karen Barton’s application (screen shot above) is designed for the iPhone and iPad, and is available for $2.99 from Appolicious. As described in the preview, the application uses photos and videos to show you how to isolate and squeeze the muscles of the pelvic floor.  You can use the stopwatch feature so to challenge yourself in three or five minute sessions.

KegelTopia (screenshot left), also for the iPhone and iPodTouch, shows you three types of pelvic floor exercises that address different aspects of muscle conditioning.  It includes a preset timer so you can focus on the exercise without keeping track of time. It costs $1.99 and can be previewed on their website and downloaded from the itunes app store.

Other phone applications  help you time and track muscle contractions.  These include the (free) Kegel Muscle Exerciser app for Android phones; and the Kegel Timer, ($2.99) for Blackberry phones. This application allows you to time and count the number of Kegel exercises performed at one sitting.

Let’s start with an explanation about what causes vaginal dryness from Dr. Machelle  Seibel, M.D., professor of Obstetrics and Gynecology at the University of Massachusetts and head of the Complicated Menopause Program there.

“Vaginal dryness can occur at any age, and its effects range from minor discomfort to chronic pain, but it can be especially troublesome for women going through menopause,” said Dr. Seibel.  ”It is most often associated with the normal decline or fluctuation of the female hormone estrogen. This fluctuation can be triggered by childbirth, breastfeeding or menopause. Dryness can also be caused by stress, certain medications, or excessive exercise.”

Dr. Seibel, who is also a spokesman for Replens Long Lasting Vaginal Moisturizer,  recommends using a personal lubricant  to keep the vaginal lining hydrated so women can continue enjoying intimacy without pain. “With too little lubrication, intercourse will cause irritation, pain and bleeding, he added. “The cells of the lining will repair over the next several days but it can be pretty uncomfortable in the meantime.”

Replens claims to deliver long-lasting lubrication rather than just short-term, temporary help during sex.  It comes as a gel in a tampon applicator.  It’s estrogen free and has no odor.

Vaginal moisturizers, like Replens, is a product category that seems to be growing every day as evidenced by the shelf-full of brands at my local Pharmaca store. According to Stacey Rosen, President of At Last Naturals, a line of “natural” products for women, “vaginal lubricants plump up the vaginal lining cells with moisture and can help return shrunken vaginal lining tissue back to normal.”

“At Last Vaginal Gel is made with Wild Yam extract an excellent source of diosgenin, a precursor to progesterone,” explained Rosen.  ”During menopause, decreasing hormone levels can cause the thinning of the vaginal walls and vaginal dryness.  Our Vaginal Gel also contains Vitamin E which is a wonderful nutrient and helps relieves the symptoms of vaginal dryness.”

Other brands I saw at Pharmaca and available online include:  Collective Wellbeing Good Glide ;  Good Clean Love; AstroGlide and Emerita Personal Lubricant.

So why are the new dosing recommendations so conservative if the benefits of vitamin D have proven to be so substantial?  The IOM said they based their recommendations on the levels needed to maintain strong bones alone since they did not believe that there was enough evidence to prove that low levels of vitamin D causes diseases. As they wrote in the recommendations: “Past cases such as hormone replacement therapy…remind us that some therapies that seemed to show promise for treating or preventing  health problem ultimately did not work out and even caused harm. That is why it is appropriate to approach emerging evidence about an intervention cautiously, but with an open mind.”

Some of the leading Vitamin D researchers expressed their disagreement with the IOM’s recommendations on the website of Grassroots Health, an organization of leading vitamin D scientists that educate healthcare practitioners and consumers about the importance of vitamin D.  They have stated that 40-75 percent of the world’s population is vitamin D deficient. Its founder and director,  Carole Baggerly, wrote that the IOM panel “set aside many studies that did not fit their narrow definition of evidence.”

Cedric F. Garland, MD, a professor of the University of California San Diego School of Medicine, said that “pending testing, the minimum intake for all men, women and children one year and older should be 2,000 IU/day and the upper limit should be 8,000 IU/day.  Moreover, adults should be tested every two years, preferably in March.

Dr. Carlos Camargo, an epidemiologist and Associate Professor of Medicine at Harvard Medical School says that public health problems like vitamin D deficiency shouldn’t be solved with a one-size fits all approach. Rather, people should get their blood level of 25(OH)D tested and tailor the vitamin D dose and frequency for their needs.  ”Vitamin D is a hormone and just like any other hormone, good health requries a level that is not too low but also not to high. This optimal level may differ for different people…but my guess is the optimal level for most people is a 25(OH)D level around 40ng/ml.”

So where does that leave us? As with hormone therapy, there is a lot of research that the public can read first-hand. And there is also a simple blood test to determine if you are vitamin D deficient. Based on those results and armed with information, you will be in a better position to discuss your options with your physician and take a vitamin D supplement in a dose that is right for you.

The website of GrassrootsHealth is a good place to start your research. It offers an enormous amount of information and video presentations by leading vitamin D researchers and scientists.  You can also order a home test kit on their website or through the Canary Club.

As further evidence of the increasing prevalence of urinary incontinence among women, a national awareness campaign, aimed at women, has launched with local events around the country. It is supported by an informative website called “Facing Our Moments,” and status as a disease of the month. Yes, November is “Bladder Health Awareness Month.” And what would an awareness campaign be without a corporate sponsor. In this case it’s Medtronic, which markets the Interstim Therapy product,  sometimes referred to as the “pacemaker for the bladder.”   Information about how this product works and who it is recommended for can be found on the company’s website.

So, if you’re among the 33 million Americans who suffer from an overactive bladder, know that there are a range of solutions that can help you.  Call your local medical center and ask if there is a specialist or clinic for bladder and other pelvic disorders. And if you do live near one that offers this expertise, let others know about it in the comment box below.  It just might help your next door neighbor!