DEAR DR. GOTT: Last night was one of my worst. No one in my house was able to sleep because I made so much noise.
I have severe rheumatoid arthritis and take numerous medications. In the last few years it has become harder to sleep each night. I moan, groan, talk, yell, mumble, etc. while I sleep. I usually do not hear myself but everyone else in the house does. Sleep medication does not help me and ear plugs do not help others.
Do you have any ideas what I can do? No one wants to stay with me. I have had sleep studies with no answers. I need help.
DEAR READER: From the separate list you enclosed with your letter, I counted 22 drugs you are presently taking, seven other drug allergies or sensitivities, and a history of medical issues that covered two typewritten pages. And, you were only born in 1945. You’ve had osteomyelitis, fractures, a pulmonary embolism, dislocation, amputations, and respiratory failure to name a few. And, you’ve seen or been operated on by more than a dozen doctors. That’s impressive but exhausting.
Because your medical history is so extensive, I cannot begin to provide an adequate answer in my column. You simply have too many conditions and take too many medications for me to provide you with anything helpful that wouldn’t fill a book. For that reason, I will simply give you some general advice about where to turn for help.
In my opinion, your first step should be to take a copy of your medical history to a rheumatologist at a top notch teaching center. You also require some direction from a dietary point of view. If you modify your meal plans and eat properly, you should be able to eliminate some of your OTC vitamins, the omeprazole, and a few others. If you incorporate extremely mild exercises each day under a physician’s direction, perhaps you can eliminate still others. If you were to visit that facility’s pain clinic, you might be able to reduce or eliminate your methadone. This will not happen over night and you cannot simply discard all the pill bottles at once but I do believe that if one care giver takes the time with you, you can substantially lower your drug requirements. I am always concerned about the potential cross reaction of one drug to another and with you on so many, the possibilities are limitless.
From what I can determine, you have gastroesophageal reflux disease, bursitis, constipation, osteoporosis, a thyroid condition, and more, yet you feel you are keeping everyone up at night only because of your rheumatoid arthritis (RA). So, we will address that issue and see if we can put it in perspective. This chronic, inflammatory disorder commonly affects the lining of the joints in the hands and feet. Cartilage is destroyed, ligaments and tendons weaken and stretch and joints lose their alignment. It is an auto-immune condition, meaning that your immune system has wrongly attacked your body’s tissues. RA is more common in women than in men and often occurs between the ages of 40 and 60. Treatment for RA is geared toward preventing further damage and lowering symptoms of swollen joints, fatigue and more. Complications increase when a person has scarring of lung tissues and blocked arteries.
With the severity of your multiple conditions, I can understand why you have been prescribed prednisone to help reduce the pain and slow the damage to your joints. Unfortunately, steroids are taken at a price. They can cause diabetes, weak bones and cataracts. You are already on a disease-modifying anti-rheumatoid drug but that, too, comes with a side effect of possible liver damage, lung infection and suppression of your bone marrow. While I am not looking to add more drugs to your long list, you might consider asking your rheumatologist if tumor necrosis factor-alpha inhibitors might be appropriate for you. Drugs in this category have been known to help reduce symptoms in general. Sadly, they too come with unwanted potential side effects to include infection and congestive heart failure but those or other RA drugs with fewer unwanted side effects are available.
You need help and direction. A good facility can work with you to reach a goal of less pain and stiffness, stabilization of your symptoms and a good night’s sleep.
Readers who would like related information can order my Health Report “Managing Chronic Pain “ by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
