DEAR READER: I know several people who have flip-flopped their days and nights because of job commitments and other reasons. They can get a good rest only in the middle of the day and have no problems remaining awake when most of us are sleeping. The impact on other members of the household is dramatic, as it is with your granddaughter. Corrections of sleeping habits will not be made overnight (no pun intended). You may be in for a long haul, and I can only hope her activities do not disrupt your sleep in the process.

Benadryl is an antihistamine with drying and sedative qualities that has been used successfully for allergies, insomnia and other unwanted symptoms. Its main ingredient, diphenhydramine hydrochloride, may cause drowsiness, dizziness, constipation, dryness of the mouth, nose and throat, and rarely, nausea and vomiting when first taken. Most of these symptoms disappear as the body adjusts to the medication. Medical follow-up is not likely unless more serious side effects such as palpitations, low blood pressure, confusion, nervousness, double vision or tremors are experienced.

Long-term side effects may increase the risk of delirium and slow thinking. A 2009 issue of the Journal of Clinical Interventions in Aging indicated that the neurotransmitter acetylcholine can interrupt the normal functioning of the central and peripheral nervous systems. The article goes on to state the side effects of the medication are cumulative, so the more a person consumes, the more of an effect it will have on the nervous system and cognition.

Dependence on any medication, even over-the-counters, could be an issue. Sleep aids should not be taken for more than a few weeks unless approved by a physician. In part, this is because a sleep aid might control nausea or vomiting that could reflect an underlying medical problem that hasn’t been addressed. I don’t see any problems with your granddaughter taking Benadryl to bring her circadian rhythm back into line, but I do believe she should do it under the guidance of her physician, who can monitor her if peculiar symptoms appear.

Alternatives include melatonin, valerian, kava, yoga and tai chi. She should avoid all caffeine, including soda, cocoa and chocolate, from late afternoon on. She should also avoid sugar, especially that found in candy and soft drinks. Foods such as dark leafy green vegetables, whole grains, cashews and legumes might help since they are high in magnesium and are a natural sedative.

To give you related information, I am sending you a copy of my Health Report “Sleep/Wake Disorders.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and forwarded to PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: As you are aware, hormonal changes occur during menopause. Those changes can produce symptoms of insomnia that can range from transient and temporary to chronic and annoying. A woman actually goes through three phases: perimenopause, menopause and postmenopause. During the first stage, estrogen levels can decline, resulting in abnormal cycles, hot flashes and temporary insomnia. Menopause occurs when a woman has remained free of a cycle for 12 months. A woman may awaken during the night (or whenever she sleeps) leading to chronic insomnia. Postmenopause can lead to still more pronounced sleep disturbances such as sleep apnea and restless-legs syndrome. So yes, there is definitely a strong link.

Estrogen is produced in the ovaries and adrenal glands in females. In menopausal women, it is prescribed to reduce the unpleasant symptoms that can plague a woman. Some physicians might choose to prescribe hormone-replacement therapy (HRT) if symptoms of menopause are severe. I don’t know that I would be one of them. That decision is best left for you to determine with your gynecologist, based on your full medical history. You might consider modifying your diet to include cucumbers, soy sprouts, garlic, green beans, yams, apples, corn, peas, olive oil, sunflower seeds and beets. During waking hours, consider adding yoga or another exercise program. Retire at about the same time each evening. Be sure your room is dark, quiet and free of distractions. Attempt to clear issues and coordinate activities before retiring so you don’t awaken at 2 a.m. to problem solve. On particularly difficult evenings, consider melatonin, an over-the-counter sleep aid.

To provide related information, I am sending you copies of my Health Reports “Menopause” and “Sleep Wake Disorders.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

I went to my physician for a regular checkup. Routine lab work indicated I had an elevated TSH (6). My doctor asked about fatigue, weight gain, hair loss, brittle nails, dry skin and more. I explained the circumstances of my former job and because of my age, I was at least perimenopausal. I was still having periods every three weeks instead of four. I felt the symptoms I had indicated hypothyroidism. I expressed my feelings and was prescribed levothyroxine, which was to continue forever. Well, I took it for six months and saw no improvement, except for a lowered TSH level. I gained back the 20 pounds and weaned myself off the medication. I still noticed no change in my health.

My question is: Could adrenal fatigue or exhaustion from the stress and being perimenopausal be factors in the elevated TSH? Could they normalize on their own when the stress is removed? I understand there are cardiac implications with levothyroxine. I don’t suffer any issues, but there is a family history on both sides. At what point does the risk outweigh the benefit? I currently feel fine, my nails are longer than they have been in years, and my hair is OK, as is my skin. My energy level is acceptable, and I wish the 20 pounds stayed off that I gained back.

DEAR READER: I can understand why your physician put you on levothyroxine, because hypothyroidism can cause fatigue, changes in hair texture and thickness, split finger nails, dry skin and irregular menstrual cycles. One striking difference is that weight gain is relatively common. However, the reversal in your case is obviously job-related.

Let’s cover a few basic differences between adrenal fatigue and hypothyroidism. Adrenal fatigue carries no specific symptoms of heart palpitations, no fluid retention, orthostatic hypotension, good flexibility of ligaments, thin and brittle nails, thin hair, insomnia, dry skin, cold intolerance and a craving for sweets. Hypothyroidism isn’t generally associated with palpitations and presents with fluid retention, no orthostatic hypotension, poor flexibility of ligaments, normal to thick nails, coarse hair, sleepiness, normal skin, heat intolerance and a craving for fats.

Stress plays an enormous role in health, affecting us in a variety of ways and worsening many medical conditions. Therefore, I cannot rule it out as having a bearing on the symptoms you have. My recommendation is to have your TSH retested to determine what your readings are without the levothyroxine. Discuss the pros and cons with your physician. Maintain a healthful diet, get adequate rest, reduce the stress in your life, and exercise regularly. The body is a truly miraculous thing. Give it some time to recharge, but don’t hesitate to seek medical intervention if appropriate.

To provide related information, I am sending you a copy of my Health Report “Thyroid Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: The amount of sleep people require varies greatly. In large part, it depends on age, health and physical and mental activity.

Many people tend to awaken sooner than they would like to because of issues, recent events or medications they might be taking. For example, there’s the overdue report, the uniform or slacks that must be picked up at the cleaners, coordination with a neighbor for transportation to a function, the dentist appointment, brakes on the car that should be checked or yard work. A person may fall into bed in sheer exhaustion, only to awaken at a most inopportune time attempting to resolve half the major issues that lie ahead.

For some, there’s the diuretic your doctor prescribed. It’s dark, everyone else is sleeping, and you, by necessity, must trudge out of bed and get to the bathroom. By the time you make the return trip and get comfortable under the blankets, you’re well awake. This leads to finding a comfortable position because of your arthritis, much tossing and turning, and a fervent prayer that you can catch another 40 winks.

You may suffer from insomnia — difficulty going to and/or remaining asleep. This condition can cause a person to awaken several times during the night, awaken too early in the morning, or be unable to fall asleep once retiring.

You may snore or have sleep apnea. Snoring will likely be reported to you by your wife the next day. I even have known people who wake themselves up snoring loudly.

Sleep apnea is an obstructive disturbance caused by the muscles in the back of the throat relaxing. The disruption will affect your quality of sleep.

Because of the many possibilities, I suggest you make an appointment with your doctor or a sleep-disorder specialist, who can help sort things out. Perhaps you simply require less sleep than you once did.

While waiting for an appointment, continue your pattern of retiring for the evening at the same time your wife does. Forfeit all daytime naps. Eat at a reasonable time so your food can begin to digest before you climb in bed. Refrain from caffeine in your diet after 5 p.m. Make sure that your bedroom is quiet and the television and lights are off before you get into bed. Then if it becomes too annoying, keep a book handy. This will either entertain you, put you back to sleep quickly, or awaken your wife when you turn the light on. That translates to two possible positives and one aggravating negative! I wish you luck.

To provide related information, am sending you a copy of my Health Report “Sleep/Wake Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I found that taking melatonin, GABA and 5 HTP work well for me. I started this treatment based on the theory that serotonin levels decrease in aging brains. I purchase the products from an herbal supply store. They don’t work quickly but I am now three months into treatment and my sleep pattern is nearly normal.

DEAR READER:
I am glad that you found a treatment that works for you. I am passing it on to my other readers who may benefit from it. I also ask that anyone who has tried or tries these products write me with their conclusions. I will print a follow up article with the results.

DEAR READER:
Fibromyalgia is a wide-spread pain condition of the muscles and joints. In order to be diagnosed with fibromyalgia you have to meet certain criteria. From your brief note I cannot determine if you truly have the condition. However, if your only symptoms are insomnia and rib pain, I doubt you have fibromyalgia. Based on the symptoms you listed, it seems that you more likely have a condition known as chest wall syndrome. It is a benign inflammation of the rib lining. It has no known cause and often resolves on its own but for some can take many months to heal. I suggest you use over-the-counter anti-inflammatories such as ibuprofen (Advil or Motrin) or naproxen sodium (Aleve). I also suggest you be examined and tested by a rheumatologist who can determine if you truly have fibromyalgia or another similar condition. He or she can then provide you with appropriate treatment options.

After months of barely sleeping, I was exhausted. One night I feel asleep on the couch in a sitting position and found that I slept like a rock. I woke up in the morning feeling fine. Since then I start out trying to sleep in bed but inevitably wind up back on the couch sleeping in a sitting position. I always feel fine in the morning but worry that this might do my body some harm down the road should it continue.

DEAR READER:
To the best of my knowledge there is no harm in sleeping on the couch in a sitting position. I would imagine that this could cause some muscle stiffness upon waking but if you are not experiencing any problems, I don’t see any reason to stop.

There are some other safe options for insomnia. Some individuals experience remarkable results with the oldest home remedy, warm milk. I don’t know why this works but suspect it has some ties to infancy (most babies fall asleep shortly after mealtimes).

One of the best remedies I have come across is melatonin. This is a naturally occurring chemical in the brain that stimulates sleep. During daylight hours the brain produces serotonin which aids in wakefulness. At night, however, the serotonin is switched to melatonin. The only catch to this remedy is that it must be dark. In today’s society most people have televisions or computers in their bedrooms and do not provide themselves with a dark, quiet, relaxing sleeping environment. Removing these devices from the room and taking a melatonin supplement one hour before bedtime may make a huge difference. Simply follow the instructions on the bottle (which can be purchased in most pharmacies, the vitamin/supplement aisle in grocery stores or health food stores). It is non-habit forming and safe for long-term use (as it is a naturally occurring chemical within the body).

If your insomnia persists I recommend you see your physician or a sleep specialist because you may have a physical reason for your sleep problems such as sleep apnea (periods in which you stop breathing while sleeping) or restless legs syndrome.

You may wish to try prescription sleep aids such as Ambien or Lunesta. These, however, can be addictive, are only recommended for short-term use and may be expensive. There has also been huge media coverage of possible side effects including sleep walking, driving and eating with associated amnesia of the event, aggressive behavior and so forth. That being said, these drugs work for thousands of people without side effects. Inappropriate use (long-term or excessive amounts) increase the risk for side effects. Ask your doctor about this option.

To give you related information, I am sending you a copy of my newly updated Health Report “Sleep/Wake Disorders”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.