Dear Dr. Roach: I am an active 70-year-old woman in good health. I have an issue with sleep that is affecting everything in my life, because I am tired most of the time. I started taking Lunesta about 20 years ago. I had teenagers and a stressful job at the time, and just needed some help to sleep. The doctor promised me that it was not addictive. Well, it is! I am now retired, and the kids are gone, so there is really no reason that I should not be able to sleep without medication — but I can’t get off of it. I take it at bedtime, and on a good night, I sleep about four hours, sometimes less. It doesn’t seem to be doing its job, but on the other hand, I can’t NOT take it. If I don’t take it or try cutting it in half, I do not sleep at all.
My primary care physician is not helpful. He says that I should just continue to take it. In fact, he increased the dosage to 3 mg, because he said that 2 mg no longer worked for me. I have tried meditation, exercise, diet changes, not eating before bed, eating before bed, magnesium, melatonin, etc. Nothing helps. I feel like I can’t live with the pills or without them. I am torn between the lesser of two evils, which is taking sleeping meds for the rest of my life or living with constant poor sleep. Do you have any suggestions? What type of professional should I see to help me taper off?
A.S.
You should see a sleep medicine specialist. Medications are not the primary treatment for stress-related insomnia: Your story shows that these medicines, although they may be appropriate for occasional short-term use, are not good long-term approaches to sleep disturbances in most people.
The most appropriate treatment is cognitive behavioral therapy for insomnia. Medications are sometimes given with a goal to taper them off over several weeks. It’s long past time to stop these 20 years of ineffective medication. In most cases, therapy is begun first, and then medicines are slowly tapered over months. Your sleep specialist will give you instructions for a slow taper.
Dear Dr. Roach: I just read your advice on when to get a flu vaccine. I have always received my flu vaccine around October-November, until the past two years, when I got it in August-September. The pharmacy offered it when I was picking up medicine. I decided to get it early for personal reasons. If the shot loses efficacy, can you receive another vaccine in the spring? I am over 65, so I get the “senior” dose. My husband and I are firm believers in following the science and have always received vaccines; it must stem from being “polio era” children.
B.V.
No, we don’t recommend a second flu vaccine in the spring, because the flu season is usually winding up by then. The flu vaccine you got in August covers you at least until March. There really isn’t any benefit to a second dose.
It is possible that this year will be different — we just don’t know — but if the recommendations change, I will write about it in this column.
I have found that those who lived through polio have a much keener appreciation of the benefits of vaccines (in general) than those who, until COVID, had never seen a devastating pandemic.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
