Sunday, May 31, 2009

Josephine Briggs, M.D., Named Director of NIH's National Center for Complementary and Alternative Medicine


National Institutes of Health (NIH) Director, Elias A. Zerhouni, M.D., has named Josephine P. Briggs, M.D., to be the director of the National Center for Complementary and Alternative Medicine (NCCAM). An accomplished researcher and physician, Dr. Briggs brings a focus on translational research to the study of complementary and alternative medicine (CAM) to help build a fuller understanding of the usefulness and safety of CAM practices that nearly two-thirds of the American public uses.
photo of Josephine Briggs, M.D.
Josephine Briggs, M.D.

“We are pleased to have Dr. Briggs return to NIH to lead NCCAM,” said Dr. Zerhouni. “She has been a leader in trans-NIH activities and her in-depth understanding of NIH and translational research will bring new opportunities to the study of CAM.”

“I am honored to be selected to lead NCCAM and welcome the opportunity to develop further the NIH investment in this exciting field of biomedical investigation,” Dr. Briggs said. “Alternative approaches to health and wellness are of enormous public interest, and we need a strong portfolio of science in this area. The NIH has already taken significant steps to build research programs to explore the potential of CAM. I look forward to working with scientists and the CAM community as well as my colleagues across the NIH to strengthen our understanding of the potential of CAM and to examine the opportunities for integration of proven CAM approaches into our Nation’s health care delivery.”

NCCAM has an annual budget of $121 million and supports CAM research at more than 260 institutions throughout the country, funds research training and career development, and provides science-based information to the public and health professionals.

On November 7, 2006, Dr. Zerhouni announced that Stephen E. Straus, M.D., NCCAM's first Director, who stepped down from his leadership of the Center for health reasons, would become a special advisor to him. At the time of Dr. Straus' death in May of 2007, Dr. Zerhouni recognized Dr. Straus' contribution to NCCAM as having articulated "an uncompromising and compelling agenda" for the new Center. In the interim, Dr. Zerhouni named Ruth L. Kirschstein, M.D., formerly the Acting Director of NIH, to be the Acting Director of NCCAM. Dr. Kirschstein has also served as the director of the National Institute of General Medical Sciences and was the first woman to be named an institute director at NIH in 1974. "We are grateful to Dr. Kirschstein, for having provided experienced leadership during this transition," noted Dr. Zerhouni today.

Dr. Briggs received her A.B. cum laude in biology from Harvard-Radcliffe College and her M.D. from Harvard Medical School. She completed her residency training in internal medicine and nephrology at the Mount Sinai School of Medicine, followed by a research fellowship in physiology at Yale School of Medicine. She was a professor of internal medicine and physiology at the University of Michigan from 1993 to 1997. From 1997 to 2006 she was director of the Division of Kidney, Urologic, and Hematologic Diseases in the National Institute of Diabetes and Digestive and Kidney Diseases. For the last year and a half she has been senior scientific officer at the Howard Hughes Medical Institute.

Dr. Briggs has published more than 125 research articles and is on the editorial boards of numerous journals. She is an elected member of the American Association of Physicians and a fellow of the American Association for the Advancement of Science. She is also a recipient of the Volhard Prize of the German Nephrological Society. Her research interests include the renin-angiotensin system, diabetic nephropathy and the effect of antioxidants in kidney disease.

The National Center for Complementary and Alternative Medicine’s mission is to explore complementary and alternative medical practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. For additional information, call NCCAM’s Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site at www.nccam.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Saturday, May 30, 2009

Rx Imagery: How to Use Your Imagination to Improve Your Health

© David S. Sobel M.D.


This article was adapted from The Healthy Mind, Healthy Body Handbook by David S. Sobel and Robert Ornstein. Publisher: DRx, Los Altos, CA, 1996. May not be reproduced without written permission.

The greatest discovery of my generation is that human beings, by changing the inner attitudes of their minds, can change the outer aspects of their lives.
- William James (1842-1910)

You may assume that "imagination" means "not real." But the thoughts, words, and images that flow from your imagination can have very real physiological consequences for your body. Your brain often cannot distinguish whether you are imagining something or actually experiencing it. (See "The Juicy Orange.")

Perhaps you've had a racing heartbeat, rapid breathing, or tension in your neck muscles while watching a movie thriller. These sensations were all produced by images and sounds on a film. During a dream, maybe your body responded with fear, joy, anger, or sadness - all triggered by your imagination. If you close your eyes and vividly imagine yourself by a still, quiet pool or relaxing on a warm beach, your body responds to some degree as though you are actually there.

Your imagination can be a very powerful resource in relieving stress, pain, and other unwanted symptoms.

You can learn to use the power of your imagination to produce calming, energizing, or healing responses in your body. You can use imagery and hypnosis to reduce anxiety, fear, and panic; decrease chronic muscle tension; decrease pain and need for pain medications; improve comfort during medical, surgical, and dental procedures; reduce the length of labor and discomfort of childbirth; control bleeding; speed healing and recovery from surgery, injury, or skin conditions such as warts and psoriasis; ease sleep problems; improve management of chronic illnesses such as diabetes, asthma, lung, and heart disease; boost your immune function; increase sense of control and mastery; change bad habits and maintain healthy ones.

Practicing Imagery and Visualization
With guided imagery, you deliberately focus your mind on a particular image. While imagery most often uses your sense of sight with visual images, you can also include the rich experiences of your mind's other senses. Adding smells, tastes, sounds, and other sensations makes the guided imagery experience more vivid and powerful.

Some people are very visual, and easily see images with their mind's eye. But if your images aren't as vivid as a really great movie, don't worry. It's normal for imagery to vary in intensity. The important thing is to focus on as much detail as possible, and strengthen the images by using all your senses. Adding real background music can also increase the impact of guided imagery.

Remember, with guided imagery, you are always completely in control. You're the movie director. You can project whatever thought or feeling you want onto your mental screen. If you don't like a particular image, thought or feeling you can redirect your mind to something more comfortable. Or you can use other images to get rid of unpleasant thoughts (you might put them on a raft and watch them float away on a river, sweep them away with a large broom, or erase them with a giant eraser). Or you can open your eyes and stop the exercise.

Included here are basic scripts for several imagery exercises. Scores of other scripts and tapes are available. You may want to tape record yourself (or someone else) reading the script so that you can concentrate fully on the imagery. Feel free to change, modify, and personalize the script any way you please. Make it your own.

Skill, Not Magic
To practice these imagery exercises you will need 10 to 30 minutes of quiet, undisturbed time. You may need to put up a "Do Not Disturb" sign and turn off the telephone. Wear loose, comfortable clothing. Sit in a comfortable chair or lie on a pad or carpeted floor with a pillow under your head. Do whatever you can to enhance your comfort. Dim the lights. Put on soft music if you like. You may wish to use a guided imagery audiotape (see below).

Don't expect miracles. Some relief may come immediately, but often these skills take time to acquire. You may need several weeks of practice before you really start to notice benefits. Practice the techniques once or twice a day, or if that's not possible, at least three to four times a week.

Watch Out
Imagery techniques are generally very safe. However, if you have symptoms such as pain, diarrhea, dizziness, nervousness, or depression, make sure you first have an appropriate medical evaluation. These imagery techniques may also change your need for certain medications, so be sure to check with your doctor. Don't practice imagery or self-hypnosis while in a car or in any situation where your safety requires full alertness and quick responses. If you experience very distressing sensations or feelings while practicing these techniques, stop and get professional help.

The Juicy Orange
You are standing in your kitchen. Imagine the time of day, the color of the countertops, the appliances, the cupboards. You hear the hum of the refrigerator. You notice a large, plump, juicy orange lying on the cutting board. You pick it up and feel its weight. You feel the texture of its dimpled, glossy skin. With a sharp knife, you carefully cut a large slice.

As you cut into the orange you notice the rich, liquidy, fragrant juice trickle onto the counter top. You see the bright whiteness of the pulp in contrast with the orange flesh. You see the small drops of orange juice forming on the cut surface. Now imagine lifting this dripping slice of orange to your mouth, and smelling its sweet, fresh scent. Your mouth begins to water as you slowly bite into the orange. It releases a flood of sweet tangy juice into your mouth.

This juicy orange imagery exercise causes most people to salivate. Just the words and multi-sensory images are enough to trigger a physiological response.

In this case it's the flow of saliva. You can learn to use the power of your imagination to control other body functions.

Rx Create Your Special Place
The purpose of this guided imagery exercise is to help you imagine a special place where you feel safe, comfortable, and relaxed. This place can be anywhere.

It might be somewhere you have been, or a place you know well. It could be a place you create from scratch, or by taking bits and pieces from places you know. You may choose to put a dwelling in your landscape: a cabin, a castle, or a cave. Here's what to do:

* Begin by closing your eyes (or if you prefer, keep your eyes open). Take several slow, deep breaths, exhaling completely after each.
* Now see if you can imagine a place where you feel completely comfortable and peaceful. It might be real or imaginary, one from your past, or someplace you've always wanted to go (it doesn't really matter, just so long as this place feels very safe and peaceful to you).
* Allow that special place to take shape slowly (there's no rush).
* As your place begins to take shape, look around. Look to your left, to your right, and all around you. What do you see?
* Enjoy the scenery: the colors, the textures, the shapes.
* Listen to the sounds of your special place - perhaps waves gently lapping at the shore, the call of a distant bird, the sound of the wind in the trees.
* Now just listen to the sounds of this wonderful place - a place that is so comfortable and peaceful to you.
* Perhaps you feel a breeze touch your face, or warm sun gently soothing your skin.
* You may feel the crunch of gravel or soft sand beneath your feet, or the comforting support of a favorite chair.
* Now touch or pick up some favorite object from your special place. Allow your fingertips to gently explore its surface (Is it smooth or rough? Wet or dry? Warm or cold?).
* Now take in a deep breath through your nose, and notice all the rich fragrances around you. Perhaps your favorite flower is in bloom. Or you may smell the pungent scent of a pine forest, or the tangy salt sea air, or the aroma of your favorite food.
* Relax and enjoy the peace, comfort and safety of your special place.
* This is your place, and nothing can harm you here. Relax, feeling thankful and happy to be here, in your special place, at this moment.
* Begin to sense that something wonderful is about to happen. Feel the tingling sensation of expecting something good.
* Know the sense of certainty. Everything is right, just as it should be.
* Now notice a soft glow of golden light from above. It begins to bathe your body. A tingling, shimmering, vibrant energy surrounds you, energizes you, soothes you, heals you.
* You are washed in bright goodness, and draw everything you need to you, as a powerful magnet. Good wishes and kind thoughts come. This goodness and healing energy seeps into your body, infusing you with a generous, boundless energy and sense of well-being.
* Feel it move through the layers of your body, deeper and deeper into each and every organ, down to the bone.
* Feel it in each and every cell, dissolving any blockages, correcting any imbalances. Enjoy this free-flowing, healthy energy sweeping through your body. Now you are relaxing; healing.
* Your body remembers how to be well, and savors this feeling of well-being. You feel peaceful and easy in your special place - a healing place - one that is always here. You know it's a place you can visit anytime, and feel this healing energy and peace. When you are ready to return, take a deep breath and exhale fully. Open your eyes and spend a few moments savoring this relaxed, healthy, comfortable feeling.
* You may want to explore different special places each time you do this exercise, or one special place may emerge as your favorite. Remember, you can visit this place any time you want to, in your mind.

Script adapted from Belleruth Naparstek

Rx Create Your Inner Advisor
You can use this type of imagery to explore the meaning of your symptoms or illness, and what you can do to improve your health. This imagery is a means of two-way communication between your mind and your body.

Begin with a general imagery exercise such as Creating a Special Place. Once you have entered your special place, invite an inner advisor to come and visit you.

Use all your senses to watch for your advisor, as the advisor may take any shape or form. Or you may have several inner advisors. They may be a person, a voice, an object, or a symbol. If you are not comfortable with what emerges, send him/her/it away, and invite another advisor.

Once you are comfortable with your advisor, ask questions. Feel free to ask anything, such as:
Are you my inner advisor?

How can I relax?

What is causing my tension? Pain? Symptom?

What do I need to do to feel better?

Who can help me?
Then wait for the answers. Be patient. They may come in any form: a picture, image, sound, word, phrase, feeling. They can come at any time. Think about what they mean to you.

Sometimes you may be surprised at the directness and clarity of an answer. In response to "What is causing my anger" one person heard back, "You need to learn to say no." If the meaning or usefulness is not clear to you right away, don't worry. It may become clearer in the days or weeks ahead.

You can use a similar technique to have an inner dialogue with a symptom you are having. For example, if you are in pain, give it a color, shape or form. Then ask your pain questions:
Why are you here?

What can I learn from you?

When will you go away?

How can we live more peaceably together?

How can I get better?
Wait for responses. This dialogue can be done with any symptom or problem.

You have untapped knowledge, insight, and wisdom which is often drowned out by the incessant chatter of a busy mind. You can use imagery techniques to give voice to your inner wisdom, and consult your own inner advisor. There is nothing mysterious or magical about it. Simply by quieting down and bringing your mind into a focused and receptive state, valuable insights can emerge. These include suggestions on how to improve your health and well-being.

Adapted from Martin Rossman, MD and the Academy for Guided Imagery

Rx Imagine Yourself Well
You have the ability to create special imagery to alleviate specific symptoms or illnesses. Use any image that is strong and vivid for you (this often involves using all your senses to create the image), and one that is meaningful to you.

The image does not have to be physiologically accurate for it to work. Just use your imagination and trust yourself. Here are examples of images that some people have found useful. Use any of these images, or make up your own.

Remember, the best ones are vivid and have meaning to you.

For Tension and Stress
A tight, twisted rope slowly untwists
Wax softens and melts
Tension swirls out of your body and down the drain

For Healing of Cuts and Injuries
Plaster covers over a crack in a wall
Cells and fibers stick together with superglue
A shoe is laced up tight
Jigsaw puzzle pieces come together

For Arteries and Heart Disease
A miniature Roto Rooter truck speeds through your arteries and cleans out the clogged pipes
Water flows freely through a wide, open river
A crew in a small boat all row together, easily and efficiently pulling the slender boat across the smooth water surface

For Asthma and Lung Disease
The tiny elastic rubber bands that constrict your airways pop open
A vacuum cleaner gently sucks the mucus from your airways
Waves calmly rise and fall on the ocean surface

For Diabetes
Small insulin keys unlock doors to hungry cells, and allow nourishing blood sugar in
An alarm goes off and a sleeping pancreas gland awakens to the smell of freshly brewed coffee

For Cancer
A shark gobbles up the cancer cells
Tumors shrivel up like raisins in the hot sun, and then evaporate completely into the air
The faucet that controls the blood supply to the tumor is turned off, and the cancer cells starve
Radiation or chemotherapy enter your body like healing rays of light; they destroy cancer cells

For Infections
White blood cells with flashing red sirens arrest and imprison harmful germs
An army equipped with powerful anti-biotic missiles attacks enemy germs
A hot flame chases germs out of your entire body

For a Weak Immune System (Immune deficiency disorders: HIV, AIDS, and others)
Sluggish, sleepy white blood cells awaken, put on protective armor, and enter the fight against the virus
White blood cells rapidly multiply like millions of seeds bursting from a single, ripe seed pod

For an Overactive Immune System (Allergies, asthma, arthritis, etc.)
Hyperalert immune cells in the fire station are reassured that the allergens have triggered a false alarm, and they can go back to playing their game of poker
The civil war ends with the warring sides agreeing not to attack their fellow citizens

For Pain
All of the pain is placed in a large, strong metal box, closed, sealed tightly and locked with a huge, strong padlock
You grasp the TV remote control and slowly turn down the pain volume until you can barely hear it; then it disappears entirely
The pain is washed away by a cool, calm river flowing through your entire body

For Depression
Your troubles and feelings of sadness are attached to big colorful helium balloons, and are floating off into a clear blue sky
A strong, warm sun breaks through dark clouds
You feel a sense of detachment and lightness, enabling you to float easily through your day

For Behavior Change
If you are somewhat shy, imagine a vivid, detailed picture of yourself walking up to people and chatting with them confidently
If you want to be more physically active, see yourself walking in the park, riding a bike, taking a dance class, or joining a sports team

Think these 8 foods are healthy? Wrong!

Skip the diet soda and potato chips and have seltzer and popcorn instead

Image: diet soda

Skip the diet soda in favor of flavored seltzer water।
Darron Cummings / AP file


By Nicole Ferring, MS, RD
Prevention Magazine
updated 9:55 a.m. ET Dec. 31, 2008

Even if you haven't bought full-fat mayo or sugary soda since blue eye shadow was in style (the first time), you may be getting duped into less-than-stellar food choices at the supermarket. The culprit? The "health halo." "From a distance, some foods seem like healthful choices because of the way they're packaged or labeled," says Janel Ovrut, MS, RD, a Boston-based dietitian. "But just because a product's marketing gives it an aura of health doesn't necessarily mean it's good for you." Here, eight notorious health food impostors, plus smarter swaps that up the nutritional ante and still give you the flavor you crave.


Baked potato chips
Yes, they're lower in fat. But they're still high in calories and low in nutrients, with little fiber to fill you up.

Smarter sub: Popcorn. You'll get the salt and crunch of chips plus fiber, and around 65 percent fewer calories per cup. Look for oil-free microwave popcorn or brands that are air-popped or popped in healthful oils such as olive or canola.

Health bonus: Heart-healthy whole grains. Adults who eat popcorn take in as much as 2 1/2 times more whole grains than people who do not, according to a recent study published in the Journal of the American Dietetic Association.

Try: Good Health HalfNaked pre-popped popcorn, made with olive oil. One serving (4 cups) has 120 calories, 0 g sat fat, 4 g fiber.


Gummy fruit snacks
Although these products may contain some juice, they're usually nothing more than candy infused with vitamins. They also contain high fructose corn syrup, which is linked with obesity, and heart-unhealthy partially hydrogenated oils.

Smarter sub: Fresh or dried fruit. Both are packed with filling fiber, which you'll miss if you opt for gummy snacks.

Health bonus: Cancer-fighting antioxidants. Real fruit is loaded with immune-boosting nutrients that fruit-flavored snacks could never mimic. A recent Greek study found that women who ate the most fruits and veggies were the least likely to develop any type of cancer.

Try: Peeled Snacks Fruit Picks dried fruit (peeledsnacks.com). One serving (one bag) of Go-Mango-Man-Go has 120 calories, 0 g sat fat, 2 g fiber.


Light ice cream
Light ice cream can have fewer calories than regular, but there's no guarantee. Take Häagen-Dazs Dulce de Leche light ice cream: With 220 calories per 1/2 cup serving, it's still higher in calories than the average full-fat ice cream, which has around 140 calories per serving. What's more, some light ice creams can lack the rich taste you crave, so you're less satisfied and may be inclined to eat more than one serving.

Smarter sub: Dairy-free ice cream. Soy and coconut milk ice creams may save you a few calories, and they have a creamy, satisfying texture.

Health bonus: Digestion-friendly fiber. Some dairy-free ice creams are made with chicory root, a natural source of inulin, a prebiotic fiber that can increase healthy bacteria in the gut and help the body absorb calcium and iron.

Try: Turtle Mountain Purely Decadent, made with coconut milk. One serving (1/2 cup) of vanilla has 150 calories, 7 g sat fat, and 6 g fiber. (Studies show that the saturated fat in coconut may not raise cholesterol like the saturated fat in butter and meat.)


Diet soda
In a 2008 study, researchers linked drinking just one diet soda a day with metabolic syndrome — the collection of symptoms including belly fat that puts you at high risk of heart disease. Researchers aren't sure if it's an ingredient in diet soda or the drinkers' eating habits that caused the association.

Smarter sub: Flavored seltzer water. It has zero calories and is free of artificial sweeteners but provides fizz and flavor. Beware of clear sparkling beverages that look like seltzer yet contain artificial sweeteners — they're no better than diet soda. Or try a sparkling juice; we recommend watering it down with seltzer to stretch your calories even further.

Health bonus: Hydration (without chemicals). Water is essential for nearly every body process.

Friday, May 01, 2009

Heath Ledger died of accidental overdose

28-year-old actor had oxycodone, anti-anxiety, sleep aids in his system

NEW YORK - The actor Heath Ledger died from an accidental overdose of six different drugs — painkillers and sedatives — the medical examiner said Wednesday, leading doctors to warn of the dangers of mixing prescription drugs.

The 28-year-old film star died “of acute intoxication” from the combination of two strong painkillers, two anti-anxiety medicines and two sleeping aids, according to the medical examiner’s office.

Among the drugs found in his body were oxycodone, a painkiller sold as OxyContin and used in other pain relievers such as Percodan and Percocet। Others included drugs sold as anti-anxiety pills Valium and Xanax, which are sedatives.

The medical examiner and police wouldn’t identify the medications Ledger had in his apartment when his body was discovered on Jan. 22, nor would they discuss who had prescribed them. It also wasn’t known why he had the drugs; he said in a newspaper interview last year that he needed sleeping pills after two stressful acting jobs.

The Drug Enforcement Administration is investigating how Ledger got the medications. It’s common for investigators to review prescriptions when so many drugs are involved in an overdose death, said spokesman Rusty Payne.

Doctors not connected with the case said it would be unlikely for one doctor to order all the drugs. However, they said it’s not unusual for people to be prescribed both painkillers and sedatives, and overdoses are not uncommon.

“This is not rock star wretched excess,” said Cindy Kuhn, a pharmacology professor at Duke University. “This is a situation that could happen to plenty of people with prescriptions for these kind of drugs.”

Kuhn said some of the drugs are long-lasting and Ledger could have taken them over a period of several days। The medical examiner’s office wouldn’t say what concentrations of each drug were found in Ledger’s blood.

“What you’re looking at here is the cumulative effects of these medications together,” said the spokeswoman, Ellen Borakove.

‘This was an accident’
Police had said they found six bottles of anti-anxiety medicines, sleeping pills and other medicine in his Manhattan apartment after the Oscar-nominated actor was discovered dead in his bed last month.

“This was not a deliberate attempt to kill himself. This was an accident,” said Lawrence Kobilinsky, head of forensic science at John Jay College in New York. He had no role in the investigation. “He just took too many drugs having similar effects on the central nervous system.”

Experts said the combination of sedatives and the other medicines likely combined to suppress his brain function and his breathing. They said that Ledger probably had been prescribed the medicine by a number of different doctors, because several of them were from the same class of drugs and used to treat similar symptoms.

“It doesn’t make sense” that one doctor would prescribe all those, said Dr. William Lee, an internal medicine specialist at the University of Texas-Southwestern in Dallas. “It’s more likely that he got them from different prescribers.”

Jane Prosser, a medical toxicologist from New York University School of Medicine, said patients can often end up with similar medications prescribed by different doctors, who are unaware of what they’re already taking.

Three of the six prescription drugs found in Ledger’s apartment had been filled in Europe, where the actor was recently filming, police said.

“If you see one doctor for one thing and you see another doctor for another thing, neither the physician nor the patient may realize they’re getting two similar medications,” Prosser said.

“Patients should be aware that this happens on a regular basis and it doesn’t just happen to celebrities।”

Ledger’s publicist, Mara Buxbaum, didn’t immediately respond to questions about the drugs that had been prescribed to the actor before his death. She released a statement Wednesday from Ledger’s father, Kim.

“While no medications were taken in excess, we learned today the combination of doctor-prescribed drugs proved lethal for our boy. Heath’s accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage.”

No mention of illegal drugs
The medical examiner cited oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine as causing the actor’s death. There was no mention of alcohol or illegal drugs.

Oxycodone, marketed as OxyContin, is used in other painkillers such as Percodan and Percocet; hydrocodone is used in a number of painkillers, including Vicodin.

Diazepam and alprazolam are the generic names for the anti-anxiety drugs Valium and Xanax, temazepam is a sleep aid sold as Restoril, and doxylamine is an antihistamine used in over-the-counter sleep aids and cold medicines.

Ledger’s masseuse found him unresponsive after she arrived for an appointment at his rented apartment. She called 911 after first repeatedly calling actress Mary Kate Olsen. Ledger had moved into the apartment last fall after he broke up with actress Michelle Williams, the mother of his 2-year-old daughter Matilda.

Ledger, nominated for an Oscar for his role as cowboy Ennis del Mar in “Brokeback Mountain,” had returned to New York from London, where he had been making a Terry Gilliam film, days before his death. He told The New York Times in November that his most recent completed roles in the Batman movie “The Dark Knight” and Bob Dylan biopic “I’m Not There” had taken a toll and caused him to lose sleep.

“Last week I probably slept an average of two hours a night,” Ledger told the Times. “I couldn’t stop thinking. My body was exhausted, and my mind was still going.” He said he had taken two Ambien pills, which only gave him an hour of sleep.

Ledger’s family returned to the actor’s hometown of Perth, Australia, on Tuesday to prepare for his funeral. Arrangements were private.

“To most of the world, Heath was an actor of immeasurable talent and promise,” Ledger’s father said on Wednesday। “We knew Heath as a loving father, as our devoted son, and as a loyal and generous brother and friend.”