June 21, 2006

Sweet Dreams

For the past couple of years, I have found it difficult to go to sleep. It takes maybe two hours, and then I awaken early. I am healthy, but feel fatigued and need an afternoon nap to help with the tiredness. Should I take sleeping pills?

It sounds as though you have chronic insomnia. The problem is a common one, affecting between 10 and 15 percent of people. It is much more common as we age, and affects women more than men. Sometimes it complicates chronic medical or psychiatric disorders.

Primary insomnia—which we suspect you have—may respond well to reprogramming your sleep habits. We presume you do not have breathing problems or restless leg syndrome. Many people with insomnia have a state of increased arousal, and brain-wave activity confirms this increased alert state.

Though some medications may work, long-term studies greater than six months have generally not been conducted. And we would recommend behavioral changes first.

Some people do not use their bedroom as strictly a “sleep room.” Reading in bed, watching television, or sewing and knitting in bed may break down the association between bed and sleep. We think televisions in the bedroom and books in bed are not good ideas.

A second measure you may find helpful is sleep restriction. Cut out that afternoon nap, and voluntarily cut the time you spend in bed.

Relaxation measures such as massage may help, or exercise in the early evening and a warm bath before sleep time may help.

Expectations and anxiety about sleep may also negatively impact sleep patterns.

Many psychologists have programs to assist in developing “sleep hygiene” behaviors. Individual therapy, perhaps for half a dozen sessions, is usually better than group sessions. And 20 to 50 minutes per session may be all that is required.

Avoid heavy evening meals, heavy evening exercise, and exciting TV programs or controversial topics of discussion before bedtime.

We hope you get relief, and wish you sweet dreams—because then you will be getting that rapid eye movement sleep that is so refreshing.

I have heard that melatonin is good for sleep disorders. Is it safe to take, and is it effective?

Melatonin is produced by a part of the brain known as the pineal gland. It appears that its function is to keep the body’s internal events synchronized with the changes between light and dark (night and day) in the environment. Melatonin was initially used to treat jet lag, a problem related to changing time zones during transmeridian travel. More than 60 million people experience transmeridian travel annually. Millions of people work at night or on permanently rotating shift schedules, which changes their sleep patterns. This work pattern was shown to alter the melatonin production by the body.

Melatonin has become a popular treatment for sleep problems. Recently researchers analyzed the data from a number of randomized trials of melatonin and sleep disorders; this work was published in a recent British Medical Journal. The design of these studies was such that any chance findings or placebo effects would be identified. The results of nine trials were studied. While it was found that melatonin has some effect on helping individuals fall asleep more readily and also increased the percentage of time the subjects slept while in bed, on statistical analysis, both these effects were not proven to be clinically significant over the placebo.

Although melatonin was not proved to be significantly effective, it was shown not to be harmful. If you travel across time zones, spend more time outdoors and avoid sleep loss prior to travel, and your adjustment to jet lag will be easier.

I am 35 years old, and have had a history of lumps in my breast. The doctors have told me that I have “benign breast disease.” My concern is that I have an aunt who had breast cancer. Should I be worried?

As much as we would like to completely reassure you, we can only do so conditionally. Benign breast disease can be divided into three groups that are significant when it comes to associations with breast cancer.

The first group is of abnormal pathology, but in which no increased cellular division or overgrowth seems to be taking place (pathologists call it nonproliferative). The second group shows evidence of increased cellular division, but the cells are normal and typical. The third group is called atypical hyperplasia, in which increased cellular division occurs with abnormal cells in the picture.

There is an increased risk of cancer that is slight in the first group and significant in the last group. The risk is usually quoted as “relative risk,” which is a comparative number to the general population. So, for example, if the risk of the general population is made to be 1, then the first group has a risk of 1.27, or 27 percent more risk, while the third group (atypical hyperplasia) has a relative risk of 4.24, or four and a quarter times the risk of the general population.

Obviously, you need to discuss the pathology report with your doctor.

The family history may also play a role, if you share a familial predisposition to breast cancer. But the condition is so common that many people have a relative who had breast cancer without necessarily being at increased genetic risk. Only 10 percent of breast cancers have a genetic link.

The good news is that careful surveillance and attention to one’s breasts make for early diagnosis. The mortality from breast cancer is only a fraction of what it used to be.

There are no clear-cut links between lifestyle and breast cancer, though rather flimsy evidence has linked saturated fat intake to the disease. We don’t recommend saturated fat to anyone—and that means cheese, butter, and animal fats—but have to confess that only tenuous links to breast cancer exist.

Enjoy your life, and don’t worry. But do maintain regular medical visits. Worry has strong negative implications for health, and a merry heart doeth good like a medicine!

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Allan R. Handysides, M.B., Ch.B., F.R.C.P. (c), is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.

Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland, 20904. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.

Sweet Dreams

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