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Dear Dr. Roach: My 32-year-old fiance gets insomnia a few times a year. He goes 40 hours without getting more than a couple hours’ sleep. Melatonin doesn’t always help. He takes melatonin only when he needs it. He is not on any other medications. He works a 3 p.m.-11 p.m. shift. He had to miss a day of work last week due to the insomnia. He doesn’t want to see a doctor about it. Any suggestions?

N.M.

Dear N.M.: Insomnia a few times a year commonly is due to stress, so I would first recommend some stress-reduction techniques, especially relaxation exercises including breathing, focused relaxation of different body parts and positive imagery. Sleep hygiene — avoiding bright lights (especially computer screens) for two hours or more before bedtime, having no caffeine after lunch and getting regular exercise — is effective in many people. Alcohol is stimulating for many, so avoid it before bedtime.

Melatonin, although it works for some people, is ineffective for many others. I am reluctant to prescribe sleep aids, as they can cause people to rely on them after a short period of time, and prolonged use can cause adverse effects, such as driving accidents and falls, especially in the elderly.

Dear Dr. Roach: I was diagnosed with peripheral artery disease in 1991. What kind of test is recommended for checking up on this? Can it be cured?

J.C.

Dear J.C.: “Peripheral artery disease” is the general term used for cholesterol plaques in the arteries, which can block blood flow. The most common symptom is pain with walking, usually after a specific exercise duration, which is relieved with rest. However, since these blockages can occur in any artery, PAD can cause many different symptoms, such as pain after eating (when the blockages are in the arteries to the gut). The disease most commonly is diagnosed by noninvasive studies, like a Doppler ultrasound of the arteries or using one blood pressure cuff on the thigh and another on the arm. Sometimes, an angiogram is necessary.

Since it’s really the same disease as coronary artery disease and cerebrovascular disease, people with PAD are at much higher risk for heart attack and stroke. Although we cannot, in general, cure PAD, we have many different kinds of treatments to reduce risk of catastrophic events and to improve symptoms.

Treatment starts with modifying existing risk factors, especially smoking, which is the most powerful modifiable risk. A proper diet that cuts down on excess unhealthy fats and simple sugars is important. A monitored exercise program, gradually increasing in duration and intensity, can have a dramatic effect on function. Most people will benefit from statin drugs and anti-platelet drugs, such as aspirin.

Email questions to ToYourGoodHealth@med.cornell.edu.

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