The Alan Titchmarsh Show 5th November 2013

ITV: The Alan Titchmarsh Show

Series 13

On todays fabulous show the Alan Titchmarsh Medical team including myself, as the resident GP, Dietician Lucy Jones and Cosmetic surgeon to the stars, Dr Dirk Kremer, discuss some fantastic health issues including Insomnia, Varicose veins, shin splints and dark circles under the eyes.

For those who wish to know more about the topics covered, read on.


So what exactly is insomnia?

Insomnia simply means poor sleep. Working as a GP, I think its one of the most common things patients mention to me and yes even Doctors get Insomnia, highlighting exactly how common the problem is.

UK Studies suggest that 30-40% of Adults do not get as much sleep as they would like.

Insomnia can mean any of the following:

  • Not being able to get off to sleep.
  • Waking up too early.
  • Waking for long periods in the night.
  • Not feeling refreshed after a night’s sleep.

If you have poor sleep, you may be tired in the daytime, have reduced concentration, become irritable, or just not function well. If the insomnia continues it can increase the risk of developing conditions including diabetes, depression, high blood pressure and strokes.

What is a normal amount of sleep?

Different people need different amounts of sleep. Some people function well and are not tired during the day with just 3-4 hours’ sleep a night. Margaret Thatcher claimed to have only slept for 4 hours per night during her entire time as British Prime minister and apparently only needed this amount to function well. Most people need more than this.

6-8 hours per night is the average amount of sleep that most people seem to need. I normally aim for 7- 8 hours and this is what most Doctors recommend. However, as you become older, it is normal to sleep less. Many people in their 70s sleep less than six hours per night.

So, everyone is different. What is important is that the amount of sleep that you get should be sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is … ‘difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness’.

What are the causes of poor sleep?

There is usually no single cause of insomnia, but there are a number of factors that can contribute to you getting it.

These are some of the main causes:

  • Physical health problems such as sleep apnoea, pain, indigestion, asthma and heart disease.
  • Psychological  health problems such as stress, anxiety, depression
  • Medicines: Poor sleep can be a side-effect of medications such as slimming pills, antidepressants or medicines to treat high blood pressure.
  • Travel: Jet lag, a temporary condition that can cause disturbed sleep patterns, digestion problems and a lack of energy (fatigue) following air travel across a number of time zones.
  • Environmental factors such as noise, an uncomfortable bed or being too hot or cold.
  • Lifestyle: Poor diet, no regular exercise, not having a regular sleep routine, having day time naps, eating late at night, drinking excessive amounts of alcohol or smoking. Stimulants such as nicotine can affect sleep.



Can it be cured?

There are lots of things that you can try to help you to sleep better. Drs call this ‘Sleep Hygiene’.

If you are having problems with your sleep try to make some of the changes below, it may make a huge difference.

  • Cut the Caffeine – do not have any food, medicines, or drinks that contain caffeine or other stimulants for six hours before bedtime. Some people have found that cutting out caffeine completely helps.
  • Banish The Cigarettes: Do not smoke within six hours before bedtime.
  • Bin the Booze: Ideally try not to drink alcohol within six hours before bedtime.
  • No Late Night Feasts: Do not have a heavy meal just before bedtime (although a light snack may be helpful).

·         Exercise helps but not late at night: Do not do any strenuous exercise within four hours of bedtime. This may increase the amount of adrenaline your body produces, making it difficult to get to sleep.

  • Get Into a Rhythm: Control your Body’s Sleep rhythm – try to get into a daily routine to establish a sleep pattern. Going to bed at the same time each night and getting up at the same time each morning, even at weekends can help. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well.

No matter how tired you are, do not sleep or nap during the day.

It is best to go to bed only when sleepy

  • Turn out the Light: Switch the light out as soon as you get into bed.


  • Make your Bedroom a Sleep Haven– The bedroom should be a quiet, relaxing place to sleep. It should not be too hot, cold, or noisy. Earplugs may be useful if you are sleeping with a partner who snores or if you are in a noisy environment.

Make sure the bedroom is dark with good curtains. Consider using eyeshades.

Don’t use the bedroom for activities such as work, eating or watching television.

  • Ditch The Phones: Avoid sleeping with your mobile phones by your bed
  • Change your bed: if it is old, or uncomfortable.
  • Stop Clock Watching- Hide any clocks. Watching the time through the night often makes insomnia worse
  • Get in the Mood– Try to relax and unwind before going to bed.

Try going for a gentle walk, then run a bath or have a shower.

Reading and having a warm drink (without caffeine) may be relaxing in the late evening.

Do not do anything that is mentally demanding within 90 minutes of going to bed – such as studying.

If you have an ‘active mind’ try making a ‘Thoughts Diary’. You can use this to write down events of the day, things that you are worried about, plans for the rest of the week etc and sometimes putting thoughts from mind to paper can help you to switch off.

Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes.


  • If you cannot get off to sleep after 20-30 minutes – then get up. If you can, go into another room, and do something else such as reading or watching TV rather than brooding in bed. Go back to bed when sleepy. You can repeat this as often as necessary until you are asleep


What Else?


Complimentary Therapies: Herbal Remedies such as Valerian, Lavender oils etc can be helpful. There is no proven scientific evidence that they work but they may be beneficial in some cases


If you have tried all of these tips and you still can’t sleep, make an appointment to see your GP.

Your doctor may refer you to a psychologist or other health professional for behavioural and/or cognitive therapies.

Sleeping tablets are not usually advised but your Doctor may prescribe them to be used short term in some cases, for example to get over a particularly bad patch.


Varicose Veins

Varicose veins are swollen and enlarged veins, usually blue or dark purple in colour. They may also be lumpy, bulging or twisted in appearance. They mostly occur in the legs.

Other symptoms include:

  • aching, heavy and uncomfortable legs
  • swollen feet and ankles
  • muscle cramp in your legs



Why do varicose veins happen?

Varicose veins develop when the small valves inside the veins stop working properly. In a healthy vein, blood flows smoothly to the heart. The blood is prevented from flowing backwards by a series of tiny valves that open and close to let blood through. If the valves weaken or are damaged, the blood can flow backwards and can collect in the vein, eventually causing it to be swollen and enlarged (varicose).

Certain things can increase your chances of developing varicose veins, such as:

  • pregnancy
  • being overweight
  • old age

Who is affected?

Varicose veins are a common condition, affecting up to three in 10 adults. Women tend to be more affected than men.

Any vein in the body can become varicose, but they most commonly develop in the legs and feet, particularly in the calves. This is because standing and walking puts extra pressure on the veins in the lower body.

Treating varicose veins

For most people, varicose veins do not present a serious health problem. They may have an unpleasant appearance, but should not affect circulation or cause long-term health problems. Most varicose veins do not require any treatment.

If your varicose veins are causing you pain or discomfort or they cause complications, they can be treated in several ways, the most common being:

  • endothermal ablation – treatment where heat is used to seal affected veins
  • sclerotherapy, which uses special foam to close the veins
  • a phlebectomy, involving surgery to remove the affected veins
  • compression stockings – specially designed to improve circulation in the legs

It is unlikely you’ll receive treatment on the NHS for cosmetic reasons, you will have to pay for this privately.

If you do require treatment it might help you to print treatment options for varicose veins to discuss with your GP

Preventing varicose veins

There is little evidence to suggest you can stop varicose veins getting worse, or completely prevent new ones developing.

However, there are ways to ease symptoms of existing varicose veins, such as:

  • avoiding standing or sitting still for long periods, trying to move around every 30 minutes
  • taking regular breaks throughout the day, raising the legs on pillows while resting to ease discomfort
  • exercising regularly, this can improve circulation and help maintain a healthy weight.

Shin Splints


Shin splints is a general term used to describe exercise-induced pain in the front of the lower legs, or shins.

The shin pain can be felt during or after strenuous activity, particularly running, or sports with sudden stops and starts, such as basketball and tennis.

The pain is felt along the shin bone (tibia), which runs down the inner part of your shin. At first you will feel a dull, aching pain. If you ignore it and continue to exercise, it can become very painful and you may have to stop exercising altogether.

It is really important not to “run through the pain” because the shin pain could be a sign of an injury to the bone and surrounding tissues in your leg. Continued force on your legs will make the injury and your pain worse.

If possible, you should stop doing the activity that is causing the problem for at least two weeks. You can still exercise during this time, but choose activities that do not put too much force on your shins, such as cycling, swimming, cross-training or yoga

Why shin splints happen

Shin splints have a number of different causes. The most common cause is medial tibial stress syndrome (MTSS).

MTSS is the result of frequent and intense periods of exercise when your body is not used to it. Long-distance running and sports that involve a lot of stopping and starting, such as basketball and tennis, increase your risk of getting MTSS. Suddenly increasing the distance and/or pace that you run are also common causes.

These activities place a considerable amount of pressure on your legs, particularly if they are carried out on hard ground, and can cause injury to the bone and surrounding tissues.

MTSS is thought to occur when the layer of connective tissue that covers the surface of the shin bone (periosteum) becomes inflamed.

It can become inflamed if too much pressure is placed on your shins, or if your foot rolls excessively when it hits the ground. This is known as over-pronation and it puts abnormal forces through the tibia and the shin bone.

The pain is usually, although not always, felt in both shins and it can take several days or even weeks to subside once activity is ceased.

Self care

You should stop the activity that caused shin splints for at least two weeks. After this time, the pain in your shins should begin to subside and you should be able to gradually resume the activity (see below).

While you are resting your legs, you can continue to do low impact activities, such as cross-training, cycling or swimming. Pool running is also a good way of maintaining  cardiovascular fitness.

Pain and swelling can be relieved by holding an ice pack against your shins (a bag of frozen peas wrapped in a tea towel works well). Do this for 10 minutes every two to three hours for the first two days.

You can also use over-the-counter painkillers, such as paracetamol and ibuprofen, to help relieve the pain and inflammation. Stretching your calf muscles and the front of your leg can also help.

It is important your running shoes give you the right amount of cushioning and support for your weight and foot type. If your foot rolls inwards, you may need to have orthotics (rigid shoe inserts) fitted.

Go to a specialist running shop if you are buying running shoes for the first time. A trained member of staff will be able to carry out a number of tests, including a gait analysis, and advise which shoes are best for you.

If you continue having problems with your shoes, a podiatrist can give a more expert opinion and look at your overall lower limb biomechanics. Podiatrists specialise in diagnosing and treating foot problems.

If you found this information useful, please check out my other blogs, where i go into more detail about the other medical issues covered in the show