I’ve taken sleeping pills for months… Is it time I gave up?

I have been on Zopiclone for 7 months and am wondering if I should stop taking it. I’m sleeping well, but I’m starting to get a headache. Do you have any advice?

Zopiclone is a Z drug, the other is Zolpidem, but these should only be used for short periods of time, perhaps a few weeks.

Long-term use can lead to dependence. People may not be able to sleep without them and suffer from side effects such as headaches, poor memory, numbness, and even anxiety and depression.

We also know that as tolerance builds up, over time people will need to use it more.

People who have been taking Z-drugs for more than a month should reduce the dose slowly due to the risk of withdrawal symptoms. These include anxiety, shivering, sweating, nausea, etc.

Some patients tell me they feel like their heart is pounding or their previous sleep problems have returned, but these are just withdrawal symptoms. It’s important to talk to your doctor and plan how to stop.

I often do this over weeks or months to make myself as comfortable as possible. Multiple attempts may be required.

For long-term sleep disturbances, the recommended treatment is CBT-i. CBT-i is a specific form of cognitive-behavioral therapy that addresses the thoughts and behaviors that cause and exacerbate insomnia.

Examples include relaxation therapy and sleep restriction. Sleep restriction encourages limiting the amount of time the patient is in bed. They go to bed and wake up at fixed times, but the time is short to begin with and it gets longer.

This is a very complicated process and your GP or therapist will guide you. Alternatively, you can try an app like Sleepio.

Sleep hygiene is a hot topic. That means creating the best environment and mindset for sleep, with ideas like a room without technology and no exercise before bed. This won’t cure insomnia, but it’s an important help at the same time.

I was diagnosed with moderate osteoporosis after breaking my shoulder and arm 18 months ago tripping over a broken paving stone. I am 72 years old and have always eaten well and exercised. A drug called zoledronate was recommended to me, but I read that it can cause some pretty nasty dental problems, so I was worried and recently had a tooth extracted. What should I do?

Osteoporosis is the thinning of bones, which makes them weak and prone to fractures.

The goal of treatment is to prevent fractures. As we age, falls become more common due to loss of strength, stability, and balance problems.

It can get pretty serious. For example, osteoporotic hip fractures result in permanent disability in about half of those affected.

Osteoporosis is diagnosed with a DEXA scan. Results are presented as a score that translates into different stages of bone thinning.

Whether and what treatment is recommended depends on these results and a personal risk score calculated by a physician known as the fragility fracture score. You’ll score higher if you’ve already taken a break, but it also depends on other factors like age and family history. Treatment includes diet and exercise. Adequate intake of vitamin D and calcium for healthy bones is as important as incorporating weight-bearing and muscle-strengthening exercises to support bones.

The Royal Osteoporosis Society website (theros.org.uk) has helpful exercise guides and dietary advice.

Medications are important for strengthening bones, and there are various medications, including HRT, that may be suitable for some women in this case. All drugs have side effects, and if dental care is required, it is important to consider the dental complications of some osteoporosis drugs. If you have a dental problem, it’s important to tell your doctor or nurse so they can find the best treatment for you.

I just got back from vacation in Spain and my feet and ankles were swollen after getting off the plane. This has been going on for years and tests show my blood circulation is good. I am 71 years old and active. Is there any medicine I can take? When inflammation occurs, it is very painful and uncomfortable.

Such swelling, known as edema, can be unsightly and uncomfortable, but is usually harmless if all examinations are normal.

Sitting for long periods of time can slow the movement of blood from the legs back to the heart. This causes fluid in the blood to leak out of the veins into surrounding tissues, causing swelling.

Working the muscles in your legs and feet allows blood to flow back to your heart more efficiently through your veins.

Edema is worse in people with heart or blood vessel problems, so doctors do heart tests and other scans to make sure everything is normal. You may also consider special socks for airplanes. Compression stockings apply pressure to your legs, mimicking muscles and increasing blood flow. These are tailored specifically for you and you can try different strengths and lengths to see what works and is comfortable for you.

A water tablet, which is a diuretic, may also be prescribed. It may be something you can take short term to prevent these difficult symptoms during the holidays.

Did the hospital send you home without any care?

I heard an amazing story last week from the wife of a man who had a bad fall at home and was “kicked out” of the hospital.

A few days after he was admitted to the hospital, despite a broken hip and nearly unconsciousness, he received a call from hospital staff claiming he “felt ready to go home.”

Of course my wife agreed. She asked if there was any help. “Someone will come to assess,” she reassured. You will then be issued a care package including a downstairs bed, a commode and some chores. But that never happened.

Luckily, she got her friends together and secured a bed in the living room. After several days of calling, the general practitioner arranged for a toilet bowl, but I still couldn’t get in touch with anyone at the hospital.

What a shame! This scenario applies to discharge for evaluation. Introduced in 2016, the scheme sends patients who have recovered enough to leave the hospital but need additional support to go home, see an occupational health worker within days, and then organize care. Obviously this doesn’t always happen.

If you’ve ever been in a situation like this, I’d love to hear your thoughts. Please write to the above address.

Heart attacks affect women too

The NHS Instagram account was irritated by images posted on social media this week.

The photo had a photo of an overweight man holding his chest with both hands, followed by part of a heart health campaign aimed at helping people spot the signs of a heart attack. But we need to stop treating heart attacks as a problem that only affects men.

It is well known that heart attacks are often hidden in women because of an assumption among patients and some doctors that heart attacks are unique to men. That means women are late to get critical care and are more likely to die from a heart attack.

Heart disease kills more than twice as many women in the UK as breast cancer. It may be time for health campaign posters to reflect that as well.