Concierge Medical Practice

Concierge medical practices have increased tenfold over the past four years. Understandably so, since physicians and specialists who have converted to a direct pay or concierge practice report that they feel a stronger sense of control over their lives, income and how they deliver patient care.

Multidimensional Family Therapy

Multidimensional family therapy for adolescents is an outpatient alcohol and other drug abuse treatment for youth and involves the entire family. Multidimensional family therapy addresses adolescent drug use in terms of a network of influences stemming from the individual, family, peers and community. Multidimensional family therapy suggests that reducing unwanted behavior and increasing desirable behavior occur in multiple ways in different settings. Treatment includes individual and family sessions held in the clinic, in the home or with family members at the family court, school or other community locations. During individual sessions, the therapist and adolescent work on important developmental tasks like decision making, negotiation and problem solving skills. Teenagers acquire vocational skills and skills by communicating thoughts and feelings and learn to deal with life stressors. Family members become involved in parallel sessions. Parents examine parenting styles, distinguish influence from control and learn to have a positive and developmentally appropriate influence on children.

What Is Sleep?

For a long time, people considered sleep a uniform block of time when a person was not awake. Thanks to sleep studies done over the past several decades, people now know that sleep has distinct stages that cycle throughout the night in predictable patterns. How well rested a person is and how well a person functions depend not just on the total sleep time but on how much of the various stages of sleep a person gets each night.
The brain stays active throughout sleep and each stage of sleep appears as a distinctive pattern of electrical activity known as brain waves.
Sleep occurs in two basic types: rapid eye movement (REM) sleep and non-REM sleep (with four different stages). (See "Types of Sleep"). Typically, sleep begins with non-REM sleep. In stage 1 non-REM sleep, a person sleeps lightly and wakes easily by noises or other disturbances. During this first stage of sleep, the eyes move slowly and muscle activity slows. A person then enters stage 2 non-REM sleep, when eye movements stop. The brain shows a distinctive pattern of slower brain waves with occasional bursts of rapid waves.
When a person progresses into stage 3 non-REM sleep, brain waves become even slower; although brain waves will still occur in smaller, faster waves. By stage 4 non-REM sleep, the brain produces extremely slow waves almost exclusively. In stages 3 and 4, the person is in deep sleep, during which it is very difficult to wake up. Children who wet the bed or sleep walk tend to do so during stages 3 or 4 of non-REM sleep. Deep sleep is the "restorative" part of sleep that is necessary for feeling well rested and energetic during the day.

Types of Sleep

During REM sleep, the eyes move rapidly in various directions, even though the eyelids remain closed. Breathing also becomes more rapid, irregular and shallow and the heart rate and blood pressure increase. Dreaming typically occurs during REM sleep. During this type of sleep, arm and leg muscles feel tem­porarily paralyzed so that a person cannot "act out" any dreams that he or she may be having.
The first period of REM sleep people experience usually occurs about an hour to an hour and a half after falling asleep. After that, the sleep stages repeat themselves continuously during sleep. As the night progresses, REM sleep time becomes longer, while time spent in non-REM sleep stages 3 and 4 becomes shorter. By morning, nearly all sleep time occurs in stages 1 and 2 of non-REM sleep and in REM sleep. If something disrupts REM sleep during one night, REM sleep time is typically longer than normal in subsequent nights. Overall, almost one-half of total sleep time occurs as stages 1 and 2 non-REM sleep and about one-fifth each as deep sleep (stages 3 and 4 of non-REM sleep) and REM sleep. In contrast, infants spend half or more of their total sleep time in REM sleep. Gradually, as infants mature, the percentage of total sleep time that is REM progressively decreases to reach the one-fifth level typical of later childhood and adulthood.
Doctors do not fully understand why people dream and why REM sleep is so important. Sleep specialists know that REM sleep stimulates the brain regions used in learning and the laying down of memories. Animal studies suggest that dreams may reflect the brain sorting and selectively storing important new information acquired during wake time. While the brain processes this information, the brain might also revisit scenes from the day while pulling up older memories. This process may explain why childhood memories can be interspersed with events that are more recent.