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: Simply Sleep contains the antihistamine diphenhydramine, a common ingredient in several sleep aids. It was designed for occasional sleeplessness and difficulties falling asleep. I agree with your view and don’t believe it is meant to be taken every night. Nonetheless, I don’t know his complete medical history, whether he eats properly, exercises, is under stress, or works a swing shift. Many factors can come into play here. Your husband should speak with his physician for an opinion on the matter.

To provide 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 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: 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.

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.

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.

During his recovery, I noticed he would make moaning sounds in his sleep and when anyone would ask him if he had slept well, he often said he didn’t know or that he must have because he was in bed for 12 hours.

Most of the information I read about strokes included what he was most likely going through (emotional ups and downs and personality changes are common). I knew that this was something the family had to get through but it was hard because every now and then he would have some very normal days. I started to pick up on some clues that led me to believe he might be sleep deprived. He was and still is very driven in his recovery. I think sometimes he spent the time he should be asleep going over things in his mind and exercising in an effort to get better.

I decided to try a sound machine to help him sleep. I purchased a sound spa from HoMedics that places nature sounds, such as the ocean, rainforest, thunder, waterfalls and so forth. It also projects the time on the ceiling so that you don’t have to search for the clock to know what time it is.

I told my dad to give it a try and to try to focus on the sound and let his mind rest. The next morning he woke up and said it was the most rested he had felt in a long time. That afternoon when I got home from work he was asleep on the couch and the moaning sounds were gone. In fact, a few days later he was back to his old snore!

I believe the sound spa has helped a great deal in his recovery. I don’t know if sleep deprivation is addressed in stroke recovery but I believe it should be. I wonder if, as it seems to be in my dad’s case, the change of personality that some stroke victims have could be attributed to sleep deprivation. I would urge anyone who is caring for a stroke victim to give it a try. Even if it doesn’t work for the patient, it might be helpful for the caregiver and at under $30 it is well worth a try.

DEAR READER:
I believe sleep deprivation may be more common in stroke victims than previously thought. The product you found and recommended to your father appears to have had great results so I am passing the information on to my other readers. Regardless of the cause of the sleep deprivation this machine may be of benefit by playing relaxing natural sounds that can gently sooth the mind allowing for sleep to come more easily.

To give you related information, I am sending you a copy of my Health Report “Stroke”. 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.