Over 65 and can’t sleep? Sleeping pills not best option

Michael Roizen, M.D. and Mehmet Oz, M.D.

You may remember the comedian Irene Ryan as Granny on “The Beverly Hillbillies,” but does the name Jerry Brutsche ring a bell? He was her stunt double for 20 episodes from 1963 to 1970. So when Granny — after making and sampling a batch of moonshine — would do cartwheels, chances are it was actually her stunt double Jerry risking life and limb.

Since it’s unlikely that you have a stunt double, you’re on your own when it comes to handling slips, falls and cartwheels. If you’re 65 or older and are going to start using prescription sleeping pills or “Z-drugs” (zolpidem, zaleplon and zopiclone), watch your step! Your odds of falling and fracturing a hip are more than doubled in the first two weeks of your new prescription, and that’s a serious risk. According to a study in BioMed Central, 20 percent of women and 30 percent of men over 65 years old die within 12 months of a hip fracture.

Our advice: ■ Check to make sure a medication, such as an antidepressant, corticosteroid, diuretic or antihypertensive, isn’t the cause of your insomnia.

■ Ramp up daily walking (get sun exposure!) and other exercise. It’ll dispel stress, reset your body clock and ease joint and muscle pain.

■ Before bedtime, mindful meditation will quiet your mind.

■ Join a club, or volunteer. Increasing social interaction eases stress, making sleep easier.

Then, if your doc thinks an insomnia medication is still needed, make sure you’re steady on your feet when getting out of bed, and exercise caution when walking around.

Question: My mom thinks she needs laser treatment for her diabetic retinopathy. I’ve told her that there’s new stuff out there and that she should find out more about the latest treatments before she makes any decision. What do you think? — Doris G., Bayside, New York

Answer: You’re a good daughter, Doris. There is something pretty new that’s approved for the treatment of diabetic eye disease. For a long time, laser treatment, or panretinal photocoagulation (PRP), was the best eye docs could do to treat diabetic retinopathy. And in some cases, it still is. However, anti-VEGF treatment (“VEGF” stands for “vascular endothelial growth factors”) has been improving, and sometimes actually can reverse retinopathy and improve vision. One anti-VEGF, ranibizumab injections (Lucentis), recently was approved for all forms of retinopathy. It was found to stop disease progression for up to two years! Previously it was approved for treating wet age-related macular degeneration. Anti-VEGF therapy generally comes with fewer risks than laser surgery, which can cause a slight loss of peripheral, color and night vision.

Diabetic nonproliferative retinopathy, the first stage of the diabetic eye disease, happens when chronically high glucose levels damage blood vessels in the retina, making them leak. This can lead to macular edema — a swelling in the retina’s macula — the area responsible for your sharpest vision. Proliferative retinopathy is a more advanced stage in which the damaged retina releases VEGF (hence the anti-VEGF treatment). That causes tiny, fragile blood vessels to grow. They rupture, and more grow in their place. Scar tissue builds up, and the retina may become detached. Vision can be severely compromised, or lost entirely.

So tell your mom to explore all of her options with her ophthalmologist (make sure the doc specializes in diabetic eye disease). Her treatment might be a combo of antiVEGF and laser, or laser and then anti-VEGF. Whatever it is, good control of her diabetes — and not smoking — is essential if she wants to keep her vision sharp.