Search is on for safe, natural sleep aid
Q: I have struggled with my sleep since early adulthood. Over the years, I have taken prescription and OTC sleep aids. Now that I am 65, I would like to do something more natural. I have a very regular bedtime routine. I have a cup of ginger tea and I take 10 mg of melatonin and 500 mg of magnesium nightly. My only prescribed medication is a statin. I would like your advice/opinion as to the safety of these natural aids, as well as my statin.
A: Ginger tea, melatonin and magnesium are all very safe at recommended doses. Ginger tea has almost no risk: It can cause reflux symptoms, such as heartburn, in some people. Melatonin is also generally safe, although I usually recommend 1 mg, not 10 mg, to people in their 60s, as it is probably just as effective, and even less likely to cause the unusual side effects of headache, dizziness or nausea. The major side effect of magnesium is diarrhea, but the likelihood of that depends on the type of magnesium salt. Magnesium oxide has much more elemental magnesium than magnesium glycinate, for example, and may cause more diarrhea. A dose of 500 milligrams of magnesium salt should be safe for people with normal kidney function. None of these has significant drug interactions with each other or with a statin.
Q: What causes a sudden feeling of being nervous and having your chest beat hard and restless? One time, I ran to the hospital because I thought I was having a heart attack, but all test results came back normal, including my electrocardiogram, hormone level, potassium, complete blood count, cholesterol, uric acid, liver, blood pressure and pulse rate tests.
The doctor prescribed, and I took, a 1⁄4 tab of clonazepam as needed only. I took a 1⁄4 tab a week ago, and the next day, I was OK.
But the feeling’s back, so I took a 1⁄4 tab again last night. I felt better, but I still have the nervous feeling right now. I will be 65 years old in two weeks.
A: There are many causes of fast heart rates and restlessness. It sounds like doctors looked for some of the most important ones, such as excess thyroid hormone levels, heart rhythm disturbances and anemia.
Clonazepam is a benzodiazepine sedative, like diazepam (Valium) and others. I believe they are treating you for panic disorder, which is a very common problem and explains the sensation of restlessness and your chest beating hard. Other common symptoms include shortness of breath, sweating, shaking and chest discomfort. Many people, like you, fear they are having a heart attack, while others fear they are “going crazy” or losing control. Many people tell me they have recurrent, repetitive thoughts during the attack, such as “I’m dying” or “What do I do?”
Further evaluation is certainly called for. Clonazepam and similar drugs are effective short-term treatments, but I think you should visit your regular doctor to be sure of the diagnosis and to get an appropriate, long-term treatment. Both psychotherapy and medication therapy are effective, but both need time to work, which is why a shortterm treatment with clonazepam, or similar, is appropriate, with plans to get off that medicine when the other treatments become effective. Clonazepam is most effective when taken every day, while other treatments are just beginning.
Q: My brother-in-law (age 78) recently developed dementia. Everything after the age of about 20 is gone for him, and he lives in the past, though he does still connect with my sister. For some time now, he has taken a psychopharmaceutical (Zoloft) for post-traumatic stress disorder, stemming from earlier experiences. My question is, what is there to do in cases when past trauma(s) may have been erased from memory? Is there still a need to continue the medication? Is there any research on this matter? And, what about afflictions such as schizophrenia or bipolar and anxiety disorders that many presume to be attached to chemical problems in the brain? Do these, too, “disappear” when the memory of earlier life disappears?
A: That’s an interesting question that I couldn’t find a lot of writing on. I don’t think that past trauma entirely disappears from memory, even in people with dementia. Furthermore, years of learned behaviors due to past trauma, or to mood disorders like anxiety and depression, will not change very easily. Still, in people with very severe dementia, psychiatric medications a person has used should be reevaluated to see whether they are still needed.
Schizophrenia may be a structural brain problem: Although schizophrenia is probably not just one disease, there is evidence that schizophrenia may be caused by abnormal “pruning” of neurons during adolescence. People with schizophrenia and dementia usually do benefit from medication. Similarly, bipolar disease has clear evidence for abnormal gene expression, suggesting an underlying brain issue, which may need continued treatment even in people with dementia.
The idea that depression and anxiety are caused by a chemical imbalance — specifically with the brain neurotransmitter serotonin — may be an oversimplified explanation of a very complex issue. However, the medications we have remain moderately effective for depression.
Q: I’m a 63-year-old male with controlled blood pressure using five different meds, as well as a prescription for Synthroid due to Grave’s disease, for which I was treated with radioactive iodine. In late April, I experienced my first episode of AFib, which stopped by itself. Since then, I have had several AFib events, and like the first one, all were self-converted to a normal rhythm. Is AFib life-limiting or a condition to be controlled, like my thyroid condition?
A: Well-controlled atrial fibrillation isn’t life-limiting. Everybody with atrial fibrillation should have an evaluation as to the cause behind it (abnormal thyroid levels are a very common cause), but often a cause is never found. They should also consider medication to control the heart rate and anticoagulation medication to prevent stroke. Most people with atrial fibrillation benefit from anticoagulation medication, and most of the people who do get a stroke with known atrial fibrillation should have been recommended treatment.
Your case is unusual because you have a low risk for a stroke. (This was gathered from a clinical tool called the CHA2DS2-VASc. You have a score of 1, based on the information you have given me.) Some experts would treat you, but I think most would not treat you beyond aspirin. You should definitely have a close follow-up.
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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.