Dear Dr. Roach: Again and again, I read how vital quality sleep each night is. Well, for many years now, I have not gotten any. I have followed many suggestions, from supplements to acupuncture, without success. The only reasonable amount of sleep I get comes via a sleeping pill, which I take only when I am desperate. My question: Is the sleep that is induced chemically as beneficially as 鈥渘ormal鈥� sleep 鈥� meaning, does the benefit gained from taking a pill outweigh the possible side-effects of the medication?
C.L.
Most sleeping pills do change the type of sleep that you get, and they especially reduce the amount of REM (rapid eye motion) sleep and deep restorative sleep. That鈥檚 part of why many people wake up the day after taking a sleeping medication feeling groggy and exhausted: The brain did not get the type of sleep it needs. (Another reason may be that the medication is still in the system upon awakening, but this is less of a problem with most medications today.)
Some newer agents do not have as large a risk for disruption of the most beneficial types of sleep, but any medication taken to help sleep can cause people to become dependent on its use. Further, all types of sleep medicines have the potential to cause side-effects, the most worrisome of which, to me, is the increased potential for falls; a fall, especially in an elder person, can lead to a catastrophic cycle of disability. It鈥檚 not an exaggeration to say that sleeping pills can lead to death in a small proportion of people who take them.
Most people get good results from non-drug treatments, such as sleep hygiene, relaxation training and cognitive therapies. For people who have really tried these and have not had success, I recommend seeing an expert in sleep medicine to determine the least dangerous medication treatment.
听
Dear Dr. Roach: During a wellness ECG in May of this year, I was diagnosed with right bundle branch block. An echocardiogram indicated the following: mild mitral valve regurgitation; mild aortic valve regurgitation; mild tricuspid regurgitation; and a mildly thickened and sclerotic aortic valve.
How serious is a 鈥渟clerotic, mildly thickened aortic valve?鈥� I have a followup appointment with my cardiologist in a few months and was advised that the regurgitation problems are only 鈥渕ild;鈥� however, during another examination for a routine problem, the doctor advised that the aortic valve sclerosis should be monitored. Can you clarify any of this for me?
B.M.
The aortic valve prevents the blood that is ejected into the aorta from going backward into the left ventricle. In sclerosis, the valve becomes thickened and hardened (the word 鈥渟clerosis鈥� comes from the Greek word for 鈥渟tone鈥�).
You鈥檙e not alone: More than 25 per cent of adults over 65 will have it, as well as 50 per cent of those over 80. The risk factors for developing aortic valve sclerosis are similar to those for developing heart artery blockages, so it鈥檚 important to reduce those risks (especially blood pressure, cholesterol and smoking, if present).
The main concern is progression to developing aortic stenosis, which is a reduction in the size of the valve opening. That can cause serious problems, including heart failure, fainting and chest pains. About two per cent of people will progress from aortic sclerosis to aortic stenosis each year, which is why your doctor wants to monitor your heart valve. Severe or critical aortic stenosis may need surgery.
Regurgitation is when blood flows backward across the valve. Mitral valve and tricuspid valve regurgitation, diagnosed by echocardiogram, are extremely common, even routine, if they are described as "trivial" or "mild."
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].
