Frequently Asked Questions

Dear Dr. Rosenberg,

I fall asleep easily, but can never stay down for more than three hours. Can this be hypoglycemia? What can I do to stay asleep?

A:

First, there are behavioral techniques you can use. The two that come to mind are sleep restriction therapy and stimulus control. I discuss both of these in detail in my book Sleep Soundly Every Night, Feel Fantastic Every Day. Second, are you suffering from anxiety or depression? Both of these disorders can manifest with insomnia such as you describe. Finally, are you on any medications that might cause insomnia or could you have a sleep disorder that unbeknownst to you is waking you up? I would not write it off to hypoglycemia, and getting a consultation with a sleep specialist is probably the best way to go.

Dear Dr. Rosenberg,

I have several sleep disorders including apnea. Any advice?

A:

Yes, start by making sure your sleep apnea is being adequately treated. Any number of other sleep disorders can be secondary to untreated or incompletely treated sleep apnea.

Dear Dr. Rosenberg,

I have been sleepwalking and talking since I was a kid, (my dad did this as well). I also argue with my husband and see things while I’m asleep. Most of the time I am not 100% asleep but I am awake enough to argue my point and move around, but not awake enough to realize that what I’m talking about is nonsense. I eventually realize I need to get back to sleep. This always happens within one to two hours of falling asleep. Rarely, if ever, does this happen past midnight, and some nights it can happen over and over every 30 minutes or so. I am desperate for help. I have seen several doctors for this and all they want to do is give me tranquilizers to sleep. I don’t just want to be medicated and want to find the root of the problem. Do you have any ideas what could be causing this?

A:

This could be any number of things, from sleepwalking or confusional arousals to nighttime seizures. What I would recommend is that you see a board certified sleep specialist. He or she will undoubtedly order an overnight sleep study. This will go a long way to help determine what is going on. As complicated as your sleep problem sounds, this is definitely the next step required, There are no quick answers to a problem such as yours. It must be addressed systematically and carefully.

Dear Dr. Rosenberg,

I live in Sydney Australia and suffer from Tinnitus. During the day, I only notice it when things are quiet around me. When I go to bed, the “high pitched sound” is exaggerated. What can I do or take to get to sleep once in bed?

A:

Tinnitus is a very difficult problem. First, make sure you have an audiology study performed to insure that a hearing deficit is not responsible. There are devices called tinnitus maskers that generate what we call white noise. I have had several patients who have benefited from this type of device. In addition, although preliminary, a recent study showed melatonin might be beneficial in tinnitus.

Dear Dr. Rosenberg,

Is it true that what you eat can affect your sleep?

A:

Yes, in fact a study published this month in the Journal of Clinical Sleep Medicine demonstrated just that. It showed that diets that were low in fiber and high in saturated fat and sugar intake were associated with lighter, less restorative sleep with more arousals. The take home message is what we have suspected for a long time–a bad diet negatively affects your sleep, which in turn has adverse consequences on your health. I have been stressing good nutrition as part of treating sleep disorders for years. I’m glad to see a study that reinforces that.

Dear Dr. Rosenberg,

My wife had a stroke last year and her new neurologist wants her to get a sleep study. He thinks all stroke patients should have one. Your thoughts?

A:

Your new neurologist is obviously up on the latest studies. A study published in the journal Sleep Medicine just showed that 80% of all patients with stroke have sleep apnea. The conclusions of the authors are in agreement with your doctor. They feel all patients with stroke should be screened for sleep apnea.

Dear Dr. Rosenberg,

Does creating a comfortable sleeping environment help in rheumatoid arthritis?

A:

Yes. Make sure the room temperature is comfortable–65 to 70 degrees works for most of us. Use white noise such as a fan or white noise machine if it helps. Keep pets out of the room if they tend to disturb your sleep. Eliminate electronics such as cell phones, iPads, and laptops within 60 minutes of bedtime. Consider lavender oils or incense at bedtime. If you need a night light, make it red. Red is the least disruptive type of light when it comes to sleep.

Dear Dr. Rosenberg,

I keep getting up all night to go to the bathroom, and in the mornings I wake up with a headache. Do you know what could be causing this?

A:

This is a common sign of sleep apnea. I would suggest you have a sleep study done to find out and get treatment.

Dear Dr. Rosenberg,

I have been taking Ambien for several years. Recently my daughter called me in the middle of the night to tell me about the birth of my new grandchild. I do not have any recollection of the call. Is this a sign of Alzheimer’s or could it be the medicine?

A:

Definitely the medication. Ambien (zolpidem) causes what we call antegrade amnesia. That means that while it is active in your blood stream, it inhibits your memory for things that are happening. This is common. In fact, many people who get up to eat at night while on medications such as Ambien may find signs that they were eating in the morning and have no recollection.

Dear Dr. Rosenberg,

My 78-year-old dad was recently diagnosed with sleep apnea and is resistant to treatment. He says at his age, what difference will it make? Is it true that at his age there is no sense in treating sleep apnea?

A:

No, in fact a study published this month from China looked at just that question. People with sleep apnea with an average age of 77 were followed over five years. They compared those that were compliant with treatment versus those who refused therapy. In the therapy group, 94% were still alive after five years whereas in the non-therapy group 69% were alive. The major cause of death in the refusal to treat group was heart disease and stroke. This is another of several studies showing benefit in treatment regardless of age.

Dear Dr. Rosenberg,

My wife is 45 years old. Over the last year, she has had a hard time staying awake. Unless she is actively engaged in something, she falls asleep. She sleeps eight to nine hours a night and naps up to two hours a day. I am concerned about her driving, especially long distances. She had one of those home sleep tests for sleep apnea and it was negative. After that nothing has been done. Any ideas? I am desperate.

A:

Yes, your wife needs to be worked up for her sleepiness. I would request that your health care provider make a referral to a sleep specialist. First, home sleep tests are good in their place, but they cannot diagnose anything but sleep apnea. Your wife needs to be evaluated by a sleep specialist for other disorders that a home sleep test cannot detect which might be disrupting her sleep. This would include disorders such as narcolepsy, as well as neurological, hormonal, and metabolic disorders that can present with excessive sleepiness.

Dear Dr. Rosenberg,

My 75-year-old father has Alzheimer’s. He is in an assisted living home with my mom. He is up most of the night wandering around and giving her fits. During the day, he is asleep most of the time. Any ideas as to why or what can be done?

A:

Yes, what you are describing is called sundowning. This is very common in Alzheimer’s disease. People with Alzheimer’s frequently lose their normal sleep wake cycle. This is because the disease attacks the area of the brain that controls our circadian rhythms. Several studies have shown promising results in restoring normal rhythms with nighttime melatonin and exposure to bright light in the morning. I would address this problem with your dad’s health care provider soon. This is a major reason that many with Alzheimer’s end up in nursing homes. It causes excessive stress and anxiety for the caregiver who themselves become sleep deprived.

 

Dear Dr. Rosenberg,

How do I turn off my brain to get to sleep? I do not sleep for several hours after I hit the pillow.

A:

First, turn off all electronics, especially interactive electronics, one hour before bed and eliminate caffeine after noon. Consider a technique called constructive worrying. In this technique, you write down your problems and solutions three to four hours before bedtime and leave them in the desk drawer. Finally, meditation and a technique called progressive muscle relaxation, which I discuss in my new book Sleep Soundly Every Night, Feel Fantastic Every Day are quite useful.

Dear Dr. Rosenberg,

I have been prescribed 7.5mg Ambien for a number of years. How does one get off this drug?

A:

You do it with the help of your health care provider or a sleep specialist. Despite many studies demonstrating that a person can stop it suddenly without side effects, I usually taper my patients off it over several weeks while instituting cognitive behavioral therapy and good sleep hygiene.

Dear Dr. Rosenberg,

I had to write you about my sleep. My life has been in turmoil because I’ve had such trouble sleeping and waking to gasp for air. I’ve gained weight, am tired constantly, and afraid to go to bed at night because not only I can’t sleep, but also I am thinking someone could come into my room. I’ve been tested and have severe apnea but I also have insomnia. They fitted me with a CPAP but I just can’t use it since it causes me terrible anxiety. Please help me. I’m so very desperate for some help because no one else knows what to do with me.

A:

I have had many patients such as yourself. It is a common problem. First, you might discuss with your health care provider the use of an oral appliance to treat your sleep apnea. Second, you should see a board certified sleep specialist. There are many techniques, some of which involve desensitization and others that use short-term medications to get someone such as yourself acclimated to CPAP.

Dear Dr. Rosenberg,

Following a sleep study in January, I was diagnosed with Central Sleep Apnea. I began using a full mask Bi-Pap in February. I do feel better and have adjusted well to its nightly use. I have searched for information on any possible “cure” for central sleep apnea but have failed. For obstructive sleep apnea, weight loss can be of help. While monitored weight loss would always be a good thing to do, can it positively influence central sleep apnea in a similar fashion as with obstructive apnea? If not, can I do anything (empathizing the word, “anything”) to reverse the central sleep apnea diagnosis? Thank you!

A:

In most cases of central sleep apnea, weight loss will not work. However, in the case of complex sleep apnea, a condition where the central apneas arise because of the CPAP or BIPAP treatment of obstructive sleep apnea, weight loss by eliminating the obstructive component can work. Another example is central sleep apnea resulting from opioid use–in this case, it resolves when the opioids are stopped. Finally, in some cases of central sleep apnea due to heart disease, there may be resolution of the central sleep apnea with effective therapy of the heart disease.

Dear Dr. Rosenberg,

My husband has had two stents placed for coronary artery disease. He sleeps no more than five hours a night. He has always been a night owl, getting to bed no earlier than 2 am. From what I have heard from friends, this lack of sleep can be bad for him. He sees no reason to change his habits. What do you think?

A:

I think you are correct. Several recent studies have shown the relationship between sleep deprivation and coronary artery disease. Lack of sleep increases the release of stress hormones, as well as inflammatory mediators, that accelerate atherosclerosis. In fact, we can measure these elevations in the blood of those who do not get enough sleep. I would advise your husband to change his sleep habits. It should be part of a prevention strategy to lower his risk of further heart disease.

Dear Dr. Rosenberg,

I have sleep apnea and hate my CPAP. Try as I may, I cannot wear it. I have heard of a new treatment called oral pressure therapy. Is it effective?

A:

Oral pressure therapy is a new treatment that involves a mouthpiece connected to a suction device. When turned on, it brings the tongue and soft palate forward, theoretically opening the airway. The preliminary reports look quite promising. Although statistically not as effective as CPAP, it may be a viable alternative for those intolerant to CPAP. It has been approved by the FDA.

Dear Dr. Rosenberg,

My husband is a retiree who loves to play golf. He has sleep apnea but refuses to get it treated. Our doctor says it is very severe and could likely lead to a stroke or heart attack. I know that would ruin his golf game. I’m joking of course. However, I’m looking for anything to motivate him to get treated. Can you help?

A:

It just so happens I have the perfect study for you. In this month’s Journal of Clinical Sleep Medicine, a study about the effects of treating sleep apnea in golfers was published. The study showed that average golfers decreased their handicaps by 11% and skilled golfers by 30% after treating their sleep apnea. As a golfer, your husband should recognize what a significant improvement in performance this represents. Try that one on him and see if he will come to his senses.

Dear Dr. Rosenberg,

I have read that some carbohydrate-rich foods can help you fall asleep at night. I love candy bars. Would that work?

A:

No. When we talk about “some carbohydrates at bedtime,” we mean complex carbohydrates such as starches, whole grains, or legumes such as beans. Candy has no fiber and is what we call a simple sugar. The sugar is released almost immediately into the blood stream. This can result in excessive amounts of insulin being produced causing low blood sugar. The body then produces stress hormones such as cortisol to get the blood sugar back up. These stress hormones make it very difficult to fall or remain asleep. Therefore, simple sugars such as candy or sodas may keep you awake.

Dear Dr. Rosenberg,

When I had my yearly physical last month, my doctor said a blood test called C-Reactive Protein was elevated.  He asked if I snored and when I told him yes, he said I should be tested for sleep apnea.  He said this elevated blood test could increase my risk of heart attack or stroke.  What does that have to do with my snoring?

A:

C-Reactive Protein is a marker of inflammation, especially of the blood vessels.  It has been associated with an increased risk of heart attack and stroke.  It is frequently elevated in sleep apnea and some think it may be one of the major links of sleep apnea to atherosclerosis.  Therefore, I understand your physician’s desire to get you tested.  Most studies have shown that with treatment of sleep apnea, the C-Reactive Protein normalizes.

Dear Dr. Rosenberg,

My six-year-old has sleep apnea.  I have been told that he should have his tonsils and adenoids removed but I am a bit reluctant to do this.  What type of benefit might he get from having this done?  He is somewhat hyperactive.

A:

A recent study funded by the NIH done on 464 children demonstrated the benefits of the surgery in children with sleep apnea.  Children who underwent surgery showed improvement in sleep quality, impulse control, and quality of life.  Beneficial effects were observed, even among overweight children in whom there has been particular uncertainty about the role of surgery.  I hope that answers your question.

Dear Dr. Rosenberg,

My three year old resists going to bed every night.  As a result, he is sleeping less than he should.  My friends say not to worry about it since he will grow out of it.  What do you think?

A:

Yes, it is true that many children with sleep problems improve as they get older.  However, there may be a problem with that.  According to a study published in the British Medical Journal, children with irregular sleep schedules before the age of three continued to lag developmentally, even by age seven.  So it may be that the crucial first three years for brain development in a child is sleep dependent.  Therefore, I would urge that you try to maintain a regular sleep schedule with your toddler.

Dear Dr. Rosenberg,

Since my son has returned from a recent deployment to Afghanistan, he is having a lot of trouble sleeping and many nightmares.  He won’t discuss them with us but we are concerned.  Do you think a sleeping pill might help?

A:

No, it sounds like it is much more complicated than that.  I can’t make a diagnosis based on your question but certainly you are describing the sleep-related symptoms of PTSD.  I would urge you to have him seen either at your local VA or by a psychiatrist.  The sooner this is attended to the better for your son.

Dear Dr. Rosenberg,

Is it true eating aged cheeses can keep you awake? I love parmesan at night but I have a hard time falling asleep.

A:

Yes, it can. Aged cheeses and cured meats contain an amino acid called tyramine. This amino acid, when ingested, increases the release of a hormone called norepinephrine. Norepinephrine is a wake-promoting hormone that is part of the fight or flight sympathetic nervous system. I would definitely avoid it close to bedtime if you have problems with sleep.

Dear Dr. Rosenberg,

My 24-year-old daughter was diagnosed with narcolepsy two years ago. She has never experienced cataplexy. I looked it up and it is a sudden transient weakness brought on by emotions. So how can she have narcolepsy?

A:

Great question. It is true that cataplexy is present in the majority of narcoleptics. In fact, it is rarely, if ever, seen with any other disorder. However, up to 25% of people with narcolepsy do not experience cataplexy. Additionally in some, the cataplexy may not occur until five years after the sleepiness.

Dear Dr. Rosenberg,

I’m a 45-year-old woman who recently started, every night in my sleep, groaning loudly. It wakes up my son in another room and is honestly, getting on his nerves…and rightfully so. In my research, I found “catathrenia,” but that says it’s rare, and more common in men than women. This has been happening approximately two weeks and I don’t know what to do to stop it. Is this worthy of visiting a doctor, and if so, what type of doctor? Is there anything I could try first?

A:

Catathrenia is a groaning sound made on exhalation during sleep. It was originally thought to be a form of parasomnia such as sleepwalking or night terrors. However, several studies published over the last few years show it may be a form of sleep-disordered breathing such as sleep apnea. In fact, in one study done at Stanford, the majority of people treated with CPAP had a resolution of the catathrenia. I would seek the advice and expertise of someone board certified in sleep medicine.

Dear Dr. Rosenberg,

For some reason, I’ve been telling blatant lies in my sleep. I don’t remember them the next day, but they’re very cruel and tend to leave my husband questioning my feelings or intent. The one statement he was able to repeat, I wouldn’t even think while awake. Why am I intentionally trying to hurt my loved ones in my sleep?

A:

It sounds like you are sleep talking. Sleep talking can arise from dream or non-dream sleep. The higher brain centers in the prefrontal cortex of the sleep talker are not functioning. These centers control impulses and are involved in self-awareness. I would assure my loved ones that these utterances have no real meaning. For instance, your vocalizations might be directed at someone or something in a dream and are being misinterpreted by your bed partner.

Dear Dr. Rosenberg,

When I had my yearly physical last month, my doctor said a blood test called C-Reactive Protein was elevated.  He asked if I snored and when I told him yes, he said I should be tested for sleep apnea.  He said this elevated blood test could increase my risk of heart attack or stroke.  What does that have to do with my snoring?

A:

C-Reactive Protein is a marker of inflammation, especially of the blood vessels.  It has been associated with an increased risk of heart attack and stroke.  It is frequently elevated in sleep apnea and some think it may be one of the major links of sleep apnea to atherosclerosis.  Therefore, I understand your physician’s desire to get you tested.  Most studies have shown that with treatment of sleep apnea, the C-Reactive Protein normalizes.

Dear Dr. Rosenberg,

My six-year-old has sleep apnea.  I have been told that he should have his tonsils and adenoids removed but I am a bit reluctant to do this.  What type of benefit might he get from having this done?  He is somewhat hyperactive.

A:

A recent study funded by the NIH done on 464 children demonstrated the benefits of the surgery in children with sleep apnea.  Children who underwent surgery showed improvement in sleep quality, impulse control, and quality of life.  Beneficial effects were observed, even among overweight children in whom there has been particular uncertainty about the role of surgery.  I hope that answers your question.

Dear Dr. Rosenberg,

My three year old resists going to bed every night.  As a result, he is sleeping less than he should.  My friends say not to worry about it since he will grow out of it.  What do you think?

A:

Yes, it is true that many children with sleep problems improve as they get older.  However, there may be a problem with that.  According to a study published in the British Medical Journal, children with irregular sleep schedules before the age of three continued to lag developmentally, even by age seven.  So it may be that the crucial first three years for brain development in a child is sleep dependent.  Therefore, I would urge that you try to maintain a regular sleep schedule with your toddler.

Dear Dr. Rosenberg,

Since my son has returned from a recent deployment to Afghanistan, he is having a lot of trouble sleeping and many nightmares.  He won’t discuss them with us but we are concerned.  Do you think a sleeping pill might help?

A:

No, it sounds like it is much more complicated than that.  I can’t make a diagnosis based on your question but certainly you are describing the sleep-related symptoms of PTSD.  I would urge you to have him seen either at your local VA or by a psychiatrist.  The sooner this is attended to the better for your son.

Dear Dr. Rosenberg,

I have had insomnia for ten years. My doc back then had me taking Benedryl, but it only works at times. I have tried everything! My brain won’t shut off, my legs are restless, and I can’t get comfortable. So I get back up and it’s hours before I fall asleep. This happens four to five nights a week. Any advice?

Answer:

Yes. What you are describing is rather classic–Restless Legs Syndrome. Unfortunately, most physicians do not know that Benadryl (diphenhydramine) will make it worse. The first thing is to stop taking the Benadryl. If the pain persists, you need to talk to your health care provider about treatments for Restless Legs Syndrome. There are several excellent FDA approved therapies.

Dear Dr. Rosenberg,

I have asthma, which is particularly bad at night. My doctor started me on a medication called theophylline a few months ago and ever since I have a hard time falling asleep. It now takes me over an hour. I never had a problem before. What do you think?

Answer:

I think the medication is quite likely causing the problem. Theophylline is a good bronchodilator. Unfortunately, in some respects it has similar properties and effects as caffeine. As a result, it can interfere with sleep.

Dear Dr. Rosenberg,

My son has great difficulty getting up in the morning. This is destroying his life and career even though he is trying very hard to get up on time.

Answer:

It sounds like your son is probably struggling to wake up in the morning, which can be due to many things. A common reason is poor sleep hygiene, which entails staying up too late with excessive blue light exposure such as iPods, iPads, TV, and computers. The second is a circadian disorder called delayed sleep phase syndrome. In this disorder, one’s biological clock is set for late bedtime and late awakenings. Considering how severely you say this is affecting his life, I would recommend he see a sleep specialist to sort this out.

Dear Dr. Rosenberg,

How many sleep studies are necessary for a lifetime? I had two official studies from 2003-2004. One indicated narcolepsy, the other hypersomnia. My local VA wants a third from their facility, but their facility isn’t a strict sleep lab–it doubles during the day as another business. It’s loud during the day. Gone is the Multiple Sleep Latency Test (MSLT). I’ve heard two are good enough for a life. Is that true? Thank you!

Answer:

There is no reason to repeat a sleep study unless the individual is having breakthrough symptoms suggestive of sleep apnea while on CPAP. In this case, there may be a need to readjust the pressure setting. Another indication would be an intolerance to CPAP and the need to switch to a different pressure delivery system such as BIPAP. Finally, if you were diagnosed with narcolepsy but there is some doubt as to how the test was performed or its validity, that would be a valid indication for a new study.

Dear Dr. Rosenberg,

My 19-year-old daughter has narcolepsy. Despite an excellent response to medications for sleepiness, she remains very depressed.  I have been online with a narcolepsy support group and they say this is not unusual. Is that true?

Answer:

Yes. For an unknown reason the incidence of depression is much higher in people with narcolepsy than the general population. The most recent study put the incidence of depression at 27% and social anxiety at 25% in those with narcolepsy. We don’t yet know why this happens but it needs to be addressed and treated.

Dear Dr. Rosenberg,

I sleep no more than six hours a night on weekdays. My blood pressure has begun to increase. My health care provider says it could be due to not getting enough sleep. Is there any value to sleeping longer on the weekends? This is something I can do.

A:

Until recently I would have said that the answer is no. However, a study from Korea published this month in the journal Sleep Medicine, came to a different conclusion. People who slept six hours or less were two times more likely to develop hypertension. However, extending their sleep time on the weekend by one hour a day served to decrease the odds of developing hypertension. Therefore, there may be some real benefit to those who don’t sleep seven to eight hours on the weekdays to catch up on their sleep on the weekends.

Dear Dr. Rosenberg,

My granddaughter is 18 months old and refuses to fall asleep when placed in her bed. My daughter is at her wit’s end. She was told by her pediatrician that she should put her to bed, leave the room, and let her cry it out. He said it may be difficult on her and my son-in-law, but it works. It seems to me to be an extreme measure, which could cause harm to my granddaughter. What do you think?

A:

This is a technique called unmodified extinction or the “cry it out method.” In a recent study, children who were exposed to this technique were followed for five years and no long-term physical or psychological damage was noted. There are other techniques in which parents more gradually remove themselves from the child’s bedroom. These may be easier on the parent. However, the technique your daughter is planning on using is safe and effective. In fact, it is listed by the American Academy of Sleep Medicine as acceptable.

Dear Dr. Rosenberg,

My two-month-old daughter sleeps in bed with us. My wife is from another culture and she says that is the way she was brought up. I have heard that SIDS (Sudden Infant Death Syndrome) is more common in babies that sleep with their parents. Is that true?

A:

Yes it is. Up until recently, it was felt that as long as the parent did not consume alcohol or sedating medications that this was a safe practice. A recent study showed that even in the absence of these mitigating factors the incidence of SIDS was much higher in babies sleeping with their parents. There does not appear to be a problem with bringing babies into bed for breast feeding or other activities as long as the parents are awake.

Dear Dr. Rosenberg,

My 74-year-old mom was diagnosed with early dementia. She has been having problems with her memory and can never remember where she puts things. She snores and her new neurologist wants to do a sleep study on her. He says that sleep apnea can be the cause of some of her issues. Is this true?

A:

Yes it is. It is not uncommon for sleep apnea, especially in the elderly, to present with problems using memory and focusing. In fact, a particular area of the brain involved in memory called the hippocampus is very likely to be damaged by low oxygen levels associated with sleep apnea. I would advise you to urge your mom to be tested. If positive, there could be a significant improvement in her mental status.

Dear Dr. Rosenberg,

My eight-year-old son has sleep apnea. He is going to have an adenotonsillectomy. His pediatrician insists that he have another sleep study after surgery. Is this necessary? After all, isn’t the purpose of the procedure to cure him?

A:

Yes it is. However, the success rate of adenotonsillectomy drops in obese children. In fact, the surgery cures over 80% of children, but only 50% of those who are obese. Since we know the severe physical and cognitive damage that untreated sleep apnea can cause in children, it is important to be sure that the surgery has worked.

Dear Dr. Rosenberg,

Does light affect your circadian rhythm?

A:

Yes, light is the strongest stimulus that affects the circadian system. If exposed to light in the morning, one tends to go to bed earlier or at a normal time. If exposed to light at night, sleep will be delayed.

Dear Dr. Rosenberg,

I am HIV positive and my medications cause insomnia. I take Ambien 10mg, Xanax .5mg for sleep as well as hydrocodone 10mg and Lyrica 100mg for pain associated with peripheral neuropathy. I would like to stop the Ambien, Xanax, and hydrocodone. How do I approach this? I’ve been taking Ambien for ten years, Xanax for three, and hydrocodone and Lyrica for approximately eight years. Lack of sleep and pain are the real issues if I try to stop taking these medications. Do you have any suggestions on how to effectively eliminate these drugs without being a sleepless zombie that is in constant pain?

A:

The incidence of insomnia in HIV is much higher than the national average. Causes range from associated anxiety and depression to sleep apnea resulting from HIV medications. Additionally, in advanced stages, HIV can affect the brain and disrupt the normal sleep pattern. Therefore, it would be doing you a disservice to advise you about tapering off your medications. I would recommend you be seen by a board certified sleep physician. A case such as yours requires that degree of expertise.

Dear Dr. Rosenberg,

Is there another drug for narcolepsy other than Alertec?

A:

Yes, there are several medications other than Alertec (modafinil). One in particular, called Xyrem (sodium oxybate), is very effective for both the symptoms of cataplexy and excessive sleepiness. Additionally, there is a longer lasting form of modafinil, called Nuvigil (armodafinil) available. Finally, there are several other medications being developed. The most likely of these to be released soon are called H3 receptor antagonists. Initial studies with these drugs in narcolepsy have been very encouraging.

Dear Dr. Rosenberg,

I have been diagnosed with obstructive sleep apnea. I am not overweight (130 lbs.). I have tried the CPAP and mouthpiece without success. Are there any other options out there? I am afraid of it affecting my heart and blood pressure.

A:

The third option is surgery, but without knowing the results of your study or your oral anatomy, I cannot recommend whether this would be a good choice. However, I am wondering if your oral appliance was made by a dentist skilled in making oral appliances for sleep apnea? If you tried one of those boil and bite devices over the internet they rarely work. Another thing to consider, is your sleep apnea position-related? If the majority of events occur while you are sleeping on your back, various devices available will prevent you from sleeping in the supine position. Finally, I would not give up on the CPAP. There are many accredited sleep centers that can work with you in getting you compliant. My own center has over a 90% success rate with patients who were noncompliant previously. We use a technique called a PAP-NAP. My specially trained technicians utilize desensitization and imagery techniques with great success. You might want to inquire as to whether a center near you is versed in this or other techniques useful in patients struggling with CPAP. I hope this helps.

Dear Dr. Rosenberg,

I am a fifty-year-old man diagnosed with REM Behavior Disorder. I have been told by my doctors that people with my disorder can develop diseases like Parkinson’s. How frequent is this?

A:

REM Behavior Disorder is a disease where those afflicted paradoxically move while dreaming. The dreams are frequently violent and can result in self-injury or injury to one’s bed partner. It is estimated that 65% of those with the disorder will go on to develop a neurodegenerative disorder, most often of the Parkinson’s type. These include Parkinson’s, Dementia with Lewy bodies and Multisystem Atrophy. The lag time from diagnosis of REM Behavior Disorder until the development of one of these disorders averages ten to twenty years.

Dear Dr. Rosenberg,

I am 70 years old and have trouble learning new things. I was a great student when I was younger. However, I have been taking some classes in finance online and it much harder to retain things. I do not sleep well. Could this have anything to do with it?

A:

Great question. Actually, there has been some recent work done by researchers at the National Institutes of Health that point to this problem as we age. It would appear that delta (deep) sleep is very important for memory. As we get older, we progressively have less delta sleep and more of the lighter stages of sleep. This may be one reason that it becomes more difficult to retain new information with advancing years. Researchers are working on ways to increase deep sleep with aging. In the future, this may no longer be a problem.

Dear Dr. Rosenberg,

I am on Medicare and was diagnosed with sleep apnea. I want to try one of those oral appliances. I understand that they are now approved by Medicare. Can I just go to a dentist and get one made?

A:

Not exactly. First, you have to find out how severe your sleep apnea is. If it is mild to moderate, you can proceed to the dentist but you will need a referral from a physician. If your sleep apnea is severe, then you must first demonstrate intolerance to CPAP (Continuous Positive Airway Pressure) before you can qualify for an oral appliance. I hope this helps.

Dear Dr. Rosenberg,

My husband was recently discharged from our local hospital after being treated for congestive heart failure. During his hospitalization, the nurses had a hard time keeping his oxygen levels up while asleep. They said he seemed to stop breathing but there was no snoring. His cardiologist wants a sleep test. In the absence of snoring, is that really necessary?

A:

I suspect your husband probably has a form of sleep apnea called Cheyne-Stokes Central Sleep Apnea. This is very common in patients with congestive heart failure. In this form of sleep apnea, the person will hyperventilate while sleeping. This is then followed by long pauses in which no effort is made to breathe. During these pauses, oxygen levels tend to drop. Untreated, this form of sleep apnea is very damaging to the heart and will result in further deterioration and hasten death. I would strongly recommend that you have this checked out. There are excellent treatments available.

 

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