Naval Hospital Bremerton Substance Abuse Rehabilitation Program
(360) 315-3902
Building 2850
Thresher Avenue
Silverdale WA 98315

Rehabilitation Services

Primary Focus: Substance abuse treatment services
Services Provided: Substance abuse treatment
Type of Care: Outpatient, Partial hospitalization/day treatment
Special Programs/Groups: Seniors/older adults

Ophthalmology

Ophthalmology is the branch of medicine, which deals with the anatomy, physiology and diseases of the eye. The term ophthalmologist refers to a specialist in medical and surgical eye problems. Since ophthalmologists perform operations on eyes, they are both surgical and medical specialists. The eye is a fragile organ, requiring extreme care before, during, and after a surgical procedure. An expert eye surgeon must identify the need for specific procedure and be responsible for conducting the procedure safely. Anesthesia is essential for any eye surgery. Local anesthesia is most commonly used. Retrobulbar and peribulbar techniques for infiltrating the local area surrounding the eye muscle cone are to immobilize the extraocular muscles and eliminate pain sensation. Topical anesthesia using lidocaine topical gel is preferred for quick procedures. In topical anesthesia, patient cooperation is a must for a smooth procedure. General anesthesia is for children, traumatic eye injuries, major orbitotomies, and for apprehensive patients. Cardiovascular monitoring is preferable in local anesthesia and is mandatory in general anesthesia. Proper sterile precautions are used to prepare the area for surgery, including use of antiseptics like povidone-iodine. Sterile drapes, gowns and gloves are necessary. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification. An eye speculum is used to keep the eyes wide open. Although the terms laser eye surgery and refractive surgery are used as if they were interchangeable, this is not the case. Lasers may be used to treat nonrefractive conditions, while radial keratotomy is an example of refractive surgery without the use of a laser. A cataract is an opacification or cloudiness of the eye's crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the retina. If visual loss is significant, surgical removal of the lens with lost optical power is performed and it is usually replaced with a plastic intraocular lens. Due to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is necessary. LASIK is Laser-Assisted In Situ Keratomileusis. LASIK is a type of refractive surgery, performed by ophthalmologists using a laser. The operation is with the patient awake and mobile; however, the patient is sometimes given a mild sedative (such as Valium) and anesthetic eye drops. LASIK is in three steps. The first step is to create a flap of corneal tissue. The second step is remodeling of the cornea underneath the flap with the laser. Finally, the flap is repositioned.

What Disrupts Sleep?

Many factors can prevent a good sleep. These factors range from well-known stimulants, such as coffee, to certain pain relievers, decongestants and other culprits. Many people depend on the caffeine in coffee, soft drinks (for example, colas) or tea to wake up in the morning or to stay awake. Caffeine is blocks the cell receptors that adenosine uses to trigger its sleep-inducing signals. In this way, caffeine fools the body into thinking it is not tired. It can take up to eight hours for the effects of caffeine to wear off completely. Drinking a cup of coffee in the late after­noon consequently may prevent a person from falling asleep at night.
Nicotine is another stimulant that can keep a person awake. Nicotine also leads to lighter than normal sleep. Heavy smokers also tend to wake up too early because of nicotine withdrawal. Although alco­hol is a sedative that makes it easier to fall asleep, it prevents deep sleep and REM sleep, allowing only the lighter stages of sleep. People who drink alcohol also tend to wake up in the middle of the night when the effects of an alcoholic "nightcap" wear off.
Certain common prescription and over-the-counter medicines contain ingredients that can keep people awake. Many pain relievers contain caffeine. Heart and blood pressure med­ications known as "beta blockers" can cause difficulty falling asleep and increase the number of awakenings during the night. People who have chronic asthma or bronchitis also have more problems falling asleep and staying asleep than healthy people, either because of breathing difficulties or because of medicines. Other chronic painful or uncomfortable conditions, such as arthritis, congestive heart failure and sickle cell anemia, can disrupt sleep, too.
A number of psychological disorders, including schizophrenia, bipolar disorder and anxiety disorders, disrupt­ sleep. Depression often leads to insomnia and insomnia can cause depression. Some of these psychological disorders are more likely to disrupt REM sleep. Psychological stress also takes its toll on sleep, making it more difficult to fall asleep or stay asleep. People who feel stressed also tend to spend less time in deep sleep and REM sleep. Many people report having difficulties sleeping after having recently lost a loved one, are undergoing a divorce or are under stress at work.
Menstrual cycle hormones can affect how well women sleep. Progesterone is known to induce sleep and circulates in greater concentrations in the second half of the menstrual cycle. For this reason, women may sleep better during this phase of their menstrual cycle, but many women report trouble sleeping the night before their menstrual bleeding starts. This sleep disruption probably relates to the abrupt drop in progesterone levels in the bodies just before the period begins.
Certain lifestyle factors may also deprive a person of needed sleep. Large meals or exercise just before bedtime can make it harder to fall asleep. Studies show that exercise in the evening delays the extra release of melatonin at night that helps the body fall asleep. Exercise in the daytime, on the other hand, is linked to improved nighttime sleep.
Most people report that it is easier to fall asleep after having time to wind down into a less active state before sleeping. Relaxing in a hot bath before bedtime may help a person fall asleep. Body temperature also drops after a hot bath in a way that mimics, in part, what happens as the falls asleep. Probably for both these reasons, many people report that falling asleep more easily after a hot bath.
Sleeping environment also can affect sleep. Clear the bedroom of any potential sleep distractions, such as noises, bright lights, a television or computer. Having a comfortable mattress and pillow can help promote a good sleep. People also sleep better if the temperature in the bedroom is on the cool side.