Do you have trouble getting back to sleep?

Q: My husband has tried many sleep aids over the years, but they don’t KEEP him asleep. He falls asleep in just minutes but wakes up about four or five hours later and cannot get back to sleep.

He currently takes trazodone and it doesn’t help. Neither have Ambien, Lunesta or melatonin.

He is active during the day. He tried counseling, but dropped out and refuses to go back. Do you have any ideas that might help?

A: There are two prescription medications that are supposed to help with this problem. One is Intermezzo (zolpidem). It is for treating insomnia “when a middle-ofthe-night awakening is followed by difficulty returning to sleep.”

Intermezzo contains the same active ingredient as Ambien, but it is a sublingual tablet (under the tongue) that goes to work much more quickly.

This is appropriate only if there are at least four more hours before time to get up, though. If he has to get up in two or three hours, he may have morning grogginess and might not be able to drive safely. It also may cause nausea or headache.

Silenor (doxepin) is for “the treatment of insomnia characterized by difficulty with sleep maintenance.” That is a fancy way of describing your husband’s problem. This antidepressant medicine also can cause next-day drowsiness, nausea or a rise in blood pressure. Unlike Intermezzo, which is taken if and when the patient wakes up, Silenor is taken half an hour before bedtime.

He will need to discuss either of these with his doctor. He also might try a natural remedy. According to Dr. Tieraona Low Dog California poppy can also help a person stay asleep, especially if muscle pain or cramping is waking him up. Look for a tincture of Eschscholzia californica. This is not an opium poppy.

Q: Is it safe to take baking soda and water three times a day? For years I had acid reflux and heartburn, and took pills for relief.

Gradually, the pills stopped working. I had surgery to repair a hiatal hernia. That relieved the acid reflux, but I still have heartburn. The baking soda helped somewhat, but I read that it is not good for people with high blood pressure. Are there any other remedies for heartburn?

A: Baking soda in water (1/2 teaspoon in 4 ounces) is a traditional heartburn remedy that works quite well. It is pretty high in sodium though, with 616 mg in each 1/2 teaspoon. If you used this remedy three times a day, the sodium would add up to 1,848 mg. That could be enough to raise blood pressure and explains why you should not use it for more than two weeks.

There are some other simple remedies that you might find helpful against heartburn. Try chewing gum after your meal. One clinical trial found that Orbit gum is effective for these symptoms. Another found that an after-dinner walk reduced heartburn.

Another possible approach is an herbal tea of anise, lemon balm, chamomile or ginger. Ginger ale or candied ginger also can help.

We are sending you our Guide to Digestive Disorders so you can learn more about these and other simple remedies for heartburn. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. G-3, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy. com.