From the FMS Global News Desk of Jeanne Hambleton

Courtesy of the National Sleep Foundation  November 23, 2009

Sleep deprivation can have an enormous impact on your health and happiness. Apparently, it can also affect your ability to make split-second decisions, according to a recent study in the journal SLEEP. Researchers at the University of Texas at Austin split 49 West Point cadets into two groups, 21 of whom were deprived of sleep and 28 of whom were well-rested, and tested them on tasks that require quick decisions. According to the study, participants in each group performed the tasks twice, separated by a 24-hour period. Cadets who were sleep-deprived between testing periods saw their accuracy decline by 2.4 percent, and cadets who were well-rested between testing periods improved by 4.3 percent. W. Todd Maddox, one of the researchers, told HealthDay that the type of thinking tested in this study is “critical in situations when soldiers need to make split-second decisions based about whether a potential target is an enemy soldier, a civilian or one of their own.” While people vary in their need for sleep, experts agree that for most adults the amount needed to feel one’s best is somewhere between seven and nine hours per night.


More often than not, you have a pretty good idea of what is keeping you awake at night — from the cat scratching at your bedroom door to the snoring partner next to you. But not all “sleep stealers” are obvious. Here are some big sleep stealers that could be keeping you up at night and you may not know it.

Psychological Factors Stress is considered by most sleep experts to be the number one cause of short-term sleeping difficulties. You are not going to solve all your problems while sitting in bed at night, so give it a rest and get some rest.

Lifestyle Stressors Without realizing it, you may be doing things during the day or night that can work against getting a good night’s sleep. These include drinking alcohol or beverages containing caffeine in the afternoon or evening, exercising close to bedtime, following an irregular morning and night time schedule, and working or doing other mentally intense activities right before or after getting into bed.

Medications In addition, certain medications such as decongestants, steroids and some medicines for high blood pressure, asthma, or depression can cause sleeping difficulties as a side effect.


Do you find it difficult to get out of bed in the morning? Do you sometimes feel sleepy while watching television or driving? If so, you may be one of the millions of Americans who suffer from excessive sleepiness, a condition that can significantly reduce quality of life, decrease productivity and interfere with relationships. Most people feel tired occasionally, but excessive sleepiness that persists is neither normal nor healthy.


One of the primary causes of excessive sleepiness is self-imposed sleep deprivation. In the U.S. and many other parts of the world, sleep loss may occur as a result of economic or societal pressures. People may skimp on sleep in hopes of getting more done, and widespread access to technology makes it possible to stay busy (at the computer, for example) around the clock. By some estimates, people now sleep about 20 percent less than they did a century ago.

Working at night and sleeping during the day can also cause excessive sleepiness. Some people are able to adjust to such a schedule. However, others may never overcome the body’s natural tendency to be awake during the day and asleep at night. A similar phenomenon occurs with jet lag, in which the body is “out of sync” with the natural environment. In general, symptoms of jet lag increase with the number of time zones crossed. That is, someone flying from Beijing to San Francisco is more likely to suffer worse jet lag than someone flying from San Francisco to New York.

Excessive sleepiness is also linked with a number of primary sleep disorders. For example, sleep disordered breathing (SDB), which includes snoring and obstructive sleep apnea (OSA), is often associated with excessive sleepiness. Because SDB may result in frequent interruptions during sleep, it can lead to abnormal sleepiness during waking hours no matter how many hours a person actually spent in bed.

Insomnia is another main cause of perceived daytime sleepiness or fatigue. Insomnia symptoms may include difficulty falling asleep, difficulty staying asleep, and/or waking up still tired as well as daytime impairments such as excessive sleepiness, cognitive deficits (e.g., concentration and memory problems), fatigue, and irritability.

Narcolepsy is a neurological disorder characterized by disabling sleepiness. Most patients begin to experience symptoms in their teens or 20s, but symptoms may appear in younger children or older adults. Narcolepsy is also recognized by insomnia at bedtime, sudden sleep attacks, cataplexy (sudden muscular weakness), hallucinations, and sleep paralysis.

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and a strong urge to move them.  People who suffer from RLS may mistake the problem for insomnia since RLS symptoms are usually worse at night, leading to insomnia at night and excessive sleepiness during the day.

The good news is that these sleep disorders can be easily diagnosed and effectively treated. If you have excessive daytime sleepiness and/or feel you may suffer from a sleep disorder, talk to a healthcare professional about the problem as soon as possible.

Excessive sleepiness may also be caused by a variety of physical and mental illnesses as well as some medications.  If you suffer from a medical condition and you are experiencing excessive sleepiness, talk to your healthcare professional about the problem.  In many cases, properly treating the medical condition may alleviate sleepiness. In other cases, sleepiness must be treated independently.


Excessive sleepiness is not just a matter of feeling lousy – it can also affect mood, relationships, work, and quality of life.  According to the results of NSF’s 2008 Sleep in America poll:

36 percent of American drive drowsy or fall asleep while driving

29 percent of Americans fall asleep or become very sleepy at work

20 percent have lost interest in sex because they are too sleepy

14  percent report having to miss family events, work functions, and leisure activities in the past month due to sleepiness.

Each of these consequences can have an enormous impact on an individual’s health and happiness.

One of the most serious risks associated with excessive sleepiness is drowsy driving.  NSF’s 2008 poll revealed that a whopping 36 percent of American adults have nodded off or fallen asleep while driving.  Sleepiness and driving do not mix.  If you feel sleepy, you should not drive. Visit to learn how to prevent a drowsy driving-related crash.

There are several tools used to evaluate a person for excessive sleepiness.  An individual’s personal report of how they feel is also important in characterizing a sleepiness problem.  Interviewing a person’s bed partner or those sleeping nearby is also helpful in identifying things that occur during sleep (e.g., snoring and breathing pauses during sleep).

Special questionnaires developed specifically to provide insight regarding daytime sleepiness (these include the Epworth Sleepiness Scale and Stanford Sleepiness Scale). Sleep diaries may also be helpful in assessing and evaluating sleepiness as well as any underlying factors.

Additionally, there are several tests that may be employed when a sleep disorder such as SDB or narcolepsy is suspected.  Such tests may include an overnight sleep study or “polysomnogram,” and the Multiple Sleep Latency Test (MSLT).


Once a cause for excessive sleepiness is determined, there are generally a range of treatment options available to patients, including behavioral and pharmacological (drug) therapies.  For example, if the primary cause of sleepiness is OSA, continuous positive airway pressure (CPAP) or an oral appliance may be prescribed. If excessive sleepiness persists in OSA patients using CPAP or is the result of narcolepsy, approved medications may be appropriate. For sleepiness caused by voluntary sleep deprivation or poor sleep habits, treatment will center on adopting behavioral measures to make getting adequate sleep a top priority.


Although everyone should employ all the elements of good sleep hygiene, this is particularly important for anyone with excessive sleepiness.  These are behaviors and habits that can promote healthy sleep, which helps improve alertness during the day.  They include:

Maintaining a consistent sleep schedule, even on the weekends

Developing a regular, relaxing bedtime routine

Using your bedroom only for sleep and sex; if you do this, you will strengthen the  association between bed and sleep

Create a sleep environment that is dark, quiet, comfortable and slightly cool

Removing all work materials, televisions, phones, and other distractions from the bedroom

Avoiding caffeine in the second half of the day

Limiting alcohol – it can disturb sleep

For some people with excessive sleepiness, adopting healthy sleep habits is enough to resolve the problem.

People vary in their need for sleep, but experts agree that for most adults the amount needed to feel one’s best is somewhere between seven and nine hours per night.  Teens and young adults usually need nine hours of sleep or more per night.  If you suffer from excessive sleepiness that persists for more than three weeks despite allowing adequate time for sleep, discuss the problem with your healthcare professional.


GERD, also known as acid reflux, is an acronym that stands for gastroesophageal reflux disease. It is a chronic illness that affects 5-7% of the world population and is associated with serious medical complications if untreated. GERD is the 3rd most common gastrointestinal disorder in the U.S. Most patients with GERD also experience nighttime heartburn, which is more bothersome. And according to the 2001 NSF Sleep in America poll, adults in America who experience nighttime heartburn are more likely to report having symptoms of sleep problems/disorders such as insomnia, sleep apnea, daytime sleepiness and restless legs syndrome than those who don’t have night time heartburn.

GERD describes a backflow of acid from the stomach into the esophagus. Most patients with GERD experience an increase in the severity of symptoms (usually heartburn or coughing and choking) while sleeping or attempting to sleep. If the acid backs up as far as the throat and larynx, the sleeper will wake up coughing and choking. If the acid only backs up as far as the esophagus the symptom is usually experienced as heartburn.

Most people refer to GERD as heartburn, although you can have it without heartburn. Sometimes GERD can cause serious complications including inflammation of the esophagus from stomach acid that causes bleeding or ulcers. In a relatively small number of patients, GERD has been reported to result in a condition called Barrett’s esophagus, which over time can lead to cancer. Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.

GERD is common and may be frequently overlooked in children. It can cause repeated vomiting, coughing, and other respiratory problems. Talk to your child’s doctor if the problem occurs regularly and causes discomfort.

No one knows why people get GERD but factors that may contribute to it include:

age, diet, alcohol use, obesity, pregnancy, smoking.

Also, certain foods can be associated with reflux events, including:

citrus fruits, chocolate, drinks with caffeine, fatty and fried foods, garlic and onions,

mint flavorings, spicy foods, tomato-based foods, like spaghetti sauce, chili, and pizza.

GERD affects people of all ages, ethnicities and cultures and tends to run in families.


The most frequently reported symptoms of GERD are:


Acid regurgitation

Inflammation of the gums

Erosion of the enamel of the teeth

Bad breath


Chronic sore throat

Some patients with GERD experience no symptoms at all. Because of the wide range of symptoms associated with GERD and the need to distinguish it from heart-related problems, the number of medical visits and tests needed to diagnose or rule out the disease tends to be quite high.


GERD is a recurrent and chronic disease that does not resolve itself. If you are diagnosed with GERD, there are several methods of treatment which your doctor will discuss with you including behavioral modifications, medications, surgery, or a combination of methods. Over-the-counter medications may provide temporary relief but will not prevent symptoms from recurring.

The lifestyle changes you can make to minimize GERD include avoiding fats, onions, chocolate and alcohol. Losing weight may also help alleviate GERD symptoms.

Because of the association between GERD and sleep apnea, people with nighttime GERD symptoms should be screening for sleep apnea.


These lifestyle modifications should help minimize reflux:

Avoid lying down after a large meal

Eat smaller meals and maintain an upright, relaxed posture

Avoid fats, onions, chocolate and alcohol

Avoid potassium supplements

Always swallow medication in the upright position and wash it down with lots of water.


GERD is the 3rd most common gastrointestinal disorder in the US and one of the leading causes of disturbed sleep among people between the ages of 45 and 64, according to the 2002 NSF Sleep in America poll. Reviewed by William C. Orr, Ph.D.


Caffeine has been called the most popular drug in the world. It is found naturally in over 60 plants including the coffee bean, tea leaf, kola nut and cacao pod. All over the world people consume caffeine on a daily basis in coffee, tea, cocoa, chocolate, some soft drinks, and some drugs.

Because caffeine is a stimulant, most people use it after waking up in the morning or to remain alert during the day. While it is important to note that caffeine cannot replace sleep, it can temporarily make us feel more alert by blocking sleep-inducing chemicals in the brain and increasing adrenaline production.

There is no nutritional need for caffeine in the diet. Moderate caffeine intake, however, is not associated with any recognized health risk. Three 8 oz. cups of coffee (250 milligrams of caffeine) per day is considered a moderate amount of caffeine. Six or more 8 oz. cups of coffee per day is considered excessive intake of caffeine.

Caffeine enters the bloodstream through the stomach and small intestine and can have a stimulating effect as soon as 15 minutes after it is consumed. Once in the body, caffeine will persist for several hours: it takes about 6 hours for one half of the caffeine to be eliminated. There are numerous studies to support the idea that caffeine causes physical dependence. If you suspect that you or someone you know is dependent on to caffeine, the best test is to eliminate it and look for signs of withdrawal, such as headache, fatigue and muscle pain.

Although caffeine is safe to consume in moderation, it is not recommended for children. It may negatively affect a child’s nutrition by replacing nutrient-dense foods such as milk. A child may also eat less because caffeine acts as an appetite suppressant. Caffeine can be safely eliminated from a child’s diet since there is no nutritional requirement for it.

Although the FDA does not advise against women who are pregnant or nursing to eliminate caffeine from the diet, many experts recommend limiting the amount consumed during that time to one or two 8 oz. servings per day.


Caffeine is a stimulant. In moderate doses, it can:

Increase alertness

Reduce fine motor coordination

Cause insomnia

Cause headaches, nervousness and dizziness

It has also been known to result in:



Rapid heartbeat

Excessive urination

Sleep disturbance

A “caffeine crash” once the effects wear off.


If the conditions listed under “symptoms” occur, discontinue the use of caffeine. These effects are more likely to occur if caffeine is consumed in large doses. Children and women who are nursing or pregnant should avoid caffeine. People who are taking any prescription medication should talk to their doctors before consuming caffeine.

Knowing the caffeine content of your food and drinks can help you keep caffeine intake at a healthy level so you can still reap the benefits of a good night’s sleep.


In order to sleep better at night and reduce daytime sleepiness, try practicing the following sleep tips:

Maintain a regular bed and wake time schedule including weekends

Establish a regular, relaxing bedtime routine such as taking a bath or listening to music

Create a sleep-conducive environment that is dark, quiet, comfortable and cool

Sleep on a comfortable mattress and pillows

Use your bedroom only for sleep and sex

Finish eating at least 2-3 hours before your regular bedtime

Exercise regularly but avoid it a few hours before bedtime

Avoid caffeine (e.g. coffee, tea, soft drinks, chocolate) close to bedtime

Don’t smoke — not only is it a major health risk it can lead to poor sleep

Avoid alcohol close to bedtime; it can lead to disrupted sleep later in the night.


According to the 2001 Sleep in America poll, 43% of Americans are “very likely” to use caffeinated beverages to combat daytime sleepiness.

Reviewed by: Greg Belenky, M.D.


For years your doctor, your mom and your friend who goes to the gym multiple times a week have probably been telling you to eat better and exercise more. It is all you hear on television, in the newspapers and on talk radio. New doctors and dieticians usher in new diets, new fads, and so you’ve made some lifestyle changes – cutting back on your fat and sweets intake, and doing some cardiovascular exercise a few days a week. Despite all this, you still feel burned out, can’t drop those extra pounds, and don’t have the energy to greet each day with enthusiasm. What are you missing?


Though the exact mechanisms of how sleep works, how sleep rejuvenates the body and mind is still mysterious, one thing sleep specialists and scientists do know is that adequate sleep is necessary for healthy functioning. Research shows that all mammals need sleep, and that sleep regulates mood and is related to learning and memory functions. Not only will getting your zzzs help you perform on a test, learn a new skill or help you stay on task, but it may also be a critical factor in your health, weight and energy level.


An estimated 18 million Americans have sleep apnea, a sleep-related breathing disorder that leads individuals to repeatedly stop breathing during sleep. Not only does sleep apnea seriously affect one’s quality of sleep, but it can also lead to health risks such as stroke, heart attack, congestive heart failure and excessive daytime sleepiness. Sleep apnea is often associated with people who are overweight – weight gain leads to compromised respiratory function when an individual’s trunk and neck area increase from weight gain.

These interacting problems of weight gain and sleep apnea make it difficult to help oneself off the slippery slope of health problems. From a behavioral perspective, those suffering from sleep apnea may be less motivated to diet or exercise – daytime sleepiness lowers their energy levels and makes it difficult to commit to an exercise and/or diet program which would improve both their weight and sleep apnea.

Unfortunately, losing a significant amount of weight in a healthy manner can be very difficult, so Richard Simon, MD recommends treating sleep apnea first: “Unfortunately, we do not have great treatments for obesity that have long-term success rates of much greater than 5–10%,” Simon says. “Thus I prefer to start therapy with [continue positive airway pressure] (70% success rate) and then add exercise (probably less than a 50% success rate). People feel restored when they are effectively treated for sleep apnea and are more willing to start exercising then.”

Sleep deprivation may also inhibit one’s ability to lose weight – even while exercising and eating well! A 1999 study at the University of Chicago showed that restricting sleep to just 4 hours per night for a week brought healthy young adults to the point that some had the glucose and insulin characteristics of diabetics. Such sleep restriction may have been a bit extreme, but it is also not altogether uncommon in our society and is a pattern deemed the “royal route to obesity” by Eve Van Cauter, PhD, who conducted the Chicago study.


Though research shows that exercise is certainly good for one’s body and health, properly timing exercise is necessary to maximize the beneficial effects. For example, a good workout can make you more alert, speed up your metabolism and energize you for the day ahead, but exercise right before bedtime can lead to a poor night’s sleep.

All the jumping jacks in the world would not make up for a night of tossing and turning! Sleep experts recommend exercising at least three hours before bedtime, and the best time is usually late afternoon. Exercising at this time is beneficial because body temperature is related to sleep. Body temperatures rise during exercise and take as long as 6 hours to begin to drop. Because cooler body temperatures are associated with sleep onset, it’s important to allow the body time to cool off before sleep.


Are you someone who needs a fresh cup of java to coax you out of bed in the morning? Or perhaps you prefer an afternoon jolt from the cola vending machine? Or maybe you are more the candy bar type – in any case, you are not alone. In a 24/7 culture, cups of coffee, cans of soda and candy bars are staples of everyday consumers. For some, the day cannot begin without a cup of Starbucks and for many students today no study break is complete without a can of Coke. How did caffeine become the drug (and food) of choice?

In fact, lack of sleep creates a vicious cycle – the more tired you are, the more caffeine you will consume to stay awake during the day; but the more caffeine you consume, the harder it will be to fall asleep at night. Not only are foods and drinks high in caffeine likely to keep you up at night, but they are also usually replete with sugar or artificial sugar and not much else. When a healthy snack such as a carrot or granola bar is replaced with a can of Mountain Dew, you are at higher risk for putting on weight and it becomes harder to sustain energy for a longer period of time.

Food is also related to sleep by appetite and metabolism. Research by Dr. Van Cauter shows that people who do not get enough sleep are more likely to have bigger appetites due to the fact that their leptin levels (leptin is an appetite regulating hormone) fall, promoting appetite increase. This link between appetite and sleep provides further evidence that sleep and obesity are linked. To top it off, the psychological manifestations of fatigue, sleep and hunger are similar. Thus, when you are feeling sleepy you might feel like you need to head for the fridge instead of bed.


By now you probably realize that health is complex – if one part of the body system suffers, you are likely to see consequences in other areas of your life. Though diet and exercise are critical components of healthy lifestyles, it is also important to remember that sleep is inherently linked with how we eat (and how much), how we exercise (and whether or not we lose weight), and how we function on a daily basis. Getting the proper amount of sleep each night is necessary to face the world with your best foot forward. Sleep will help you on the road to good fitness, good eating and good health.


More than 85% of mammalian species are polyphasic sleepers, meaning that they sleep for short periods throughout the day. Humans are part of the minority of monophasic sleepers, meaning that our days are divided into two distinct periods, one for sleep and one for wakefulness. It is not clear that this is the natural sleep pattern of humans. Young children and elderly persons nap, for example, and napping is a very important aspect of many cultures.

As a nation, the United States appears to be becoming more and more sleep deprived. And it may be our busy lifestyle that keeps us from napping. While naps do not necessarily make up for inadequate or poor quality nighttime sleep, a short nap of 20-30 minutes can help to improve mood, alertness and performance. Nappers are in good company: Winston Churchill, John F. Kennedy, Ronald Reagan, Napoleon, Albert Einstein, Thomas Edison and George W. Bush are known to have valued an afternoon nap.


Naps can be typed in three different ways:

Planned napping (also called preparatory napping) involves taking a nap before you actually get sleepy. You may use this technique when you know that you will be up later than your normal bed time or as a mechanism to ward off getting tired earlier.

Emergency napping occurs when you are suddenly very tired and cannot continue with the activity you were originally engaged in. This type of nap can be used to combat drowsy driving or fatigue while using heavy and dangerous machinery.

Habitual napping is practiced when a person takes a nap at the same time each day. Young children may fall asleep at about the same time each afternoon or an adult might take a short nap after lunch each day.


A short nap is usually recommended (20-30 minutes) for short-term alertness. This type of nap provides significant benefit for improved alertness and performance without leaving you feeling groggy or interfering with nighttime sleep.

Your surroundings can greatly impact your ability to fall asleep. Make sure that you have a restful place to lie down and that the temperature in the room is comfortable. Try to limit the amount of noise heard and the extent of the light filtering in. While some studies have shown that just spending time in bed can be beneficial, it is better to try to catch some zzz’s.

If you take a nap too late in the day, it might affect your nighttime sleep patterns and make it difficult to fall asleep at your regular bedtime. If you try to take it too early in the day, your body may not be ready for more sleep.


Naps can restore alertness, enhance performance, and reduce mistakes and accidents. A study at NASA on sleepy military pilots and astronauts found that a 40-minute nap improved performance by 34% and alertness 100%.

Naps can increase alertness in the period directly following the nap and may extend alertness a few hours later in the day. Scheduled napping has also been prescribed for those who are affected by narcolepsy. Napping has psychological benefits. A nap can be a pleasant luxury, a mini-vacation. It can provide an easy way to get some relaxation and rejuvenation.

Most people are aware that driving while sleepy is extremely dangerous. Still, many drivers press on when they feel drowsy in spite of the risks, putting themselves and others in harm’s way. While getting a full night’s sleep before driving is the ideal, taking a short nap before driving can reduce a person’s risk of having a drowsy driving crash. Sleep experts also recommend that if you feel drowsy when driving, you should immediately pull over to a rest area, drink a caffeinated beverage and take a 20-minute nap.

Shift work, which means working a schedule that deviates from the typical “9 to 5” hours, may cause fatigue and performance impairments, especially for night shift workers. In a 2006 study, researchers at the Sleep Medicine and Research Center affiliated with St. John’s Mercy Medical Center and St. Luke’s Hospital in suburban St. Louis, MO, looked at the effectiveness of taking naps and consuming caffeine to cope with sleepiness during the night shift. They found that both naps and caffeine improved alertness and performance among night shift workers and that the combination of naps and caffeine had the most beneficial effect.

James K. Walsh, PhD, one of the researchers who conducted the study, explains, “Because of the body’s propensity for sleep at night, being alert and productive on the night shift can be challenging, even if you’ve had enough daytime sleep.” “Napping before work combined with consuming caffeine while on the job is an effective strategy for remaining alert on the night shift.”


In spite of these benefits, napping is not always the best option for everyone. For example, some people have trouble sleeping any place other than their own bed, making a nap at the office or anywhere else unlikely. Other people simply have trouble sleeping in the daytime; it could be that certain individuals are more sensitive to the midday dip than others – those who are may feel sleepier and have an easier time napping. Here are some other negative effects:

Naps can leave people with sleep inertia, especially when they last more than 10-20 minutes. Sleep inertia is defined as the feeling of grogginess and disorientation that can come with awakening from a deep sleep. While this state usually only lasts for a few minutes to a half-hour, it can be detrimental to those who must perform immediately after waking from a napping period. Post-nap impairment and disorientation is more severe, and can last longer, in people who are sleep deprived or nap for longer periods.

Napping can also have a negative effect on other sleeping periods. A long nap or a nap taken too late in the day may adversely affect the length and quality of night time sleep. If you have trouble sleeping at night, a nap will only amplify problems.

One study has indicated that napping is associated with increased risk of heart failure in people already at risk.


While research has shown that napping is a beneficial way to relieve tiredness, it still has stigmas associated with it. Napping indicates laziness, a lack of ambition, and low standards. Napping is only for children, the sick and the elderly. Though the above statements are false, many segments of the public may still need to be educated on the benefits of napping.

A recent study in the research journal Sleep examined the benefits of naps of various lengths and no naps. The results showed that a 10-minute nap produced the most benefit in terms of reduced sleepiness and improved cognitive performance. A nap lasting 30 minutes or longer is more likely to be accompanied by sleep inertia, which is the period of grogginess that sometimes follows sleep.

By now you are probably thinking about ways to incorporate naps into your daily routine. Keep in mind that getting enough sleep on regular basis is the best way to stay alert and feel your best. But when fatigue sets in, a quick nap can do wonders for your mental and physical stamina.



Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s