The new sleeping pills

Today, we will continue to respond to three selected questions sent to us by mail by our readers. I hope you’ll find the information interesting, practical and useful.

New Sleep Aids

Q. I am 64 years old and have been suffering from insomnia. My old sleeping pill doesn’t seem to help anymore. Are there new ones available in the market? Which one would you prescribe? S. C., Pasay City

A. The first thing to realize is that you are not alone — hindi kayo nagiisa. It is estimated that a third of the adult population have frequent trouble sleeping. Insomnia is not just one problem but is simply the end product of a lot of potential problems. Insomnia can occur in response to stressful events, but it may also be related to an underlying and/or undiagnosed medical condition such as depression or other psychiatric problems, chronic pain, Alzheimer’s disease, or digestive problems. People may think they have insomnia when what they have is sleep apnea (heavy snoring and interrupted breathing during sleep). You need to consult a physician and you must work together to discover the cause of sleeplessness. Underlying disorders can be treated. Evaluation at a sleep disorders center or clinic may also be appropriate.

Sleeping pills may help. They can help break the sleeplessness cycle. For many years, the benzodiazepines – so-called tranquilizers, such as diazepam (Valium), triazolam (Halcion), alprazolam (Xanor) and others, have been prescribed for insomnia. However, because of their long-lasting effects, they may leave you groggy and/or disoriented the next day. Some research has suggested that such side effects as falls may actually outweigh the benefits for older people. These drugs also tend to be habituating – that is, you may require larger doses over time. For this reason, they are approved only for short-term use.

Newer drugs, such as zolpidem (Ambien), zalephon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem) – the nonbenzodiazepines – more precisely target chemical receptors in the brain and have fewer side effects than the older drugs. Remelton, very recently approved, is different in its chemical action; it triggers the release of melatonin, a natural brain chemical that controls sleep. These medications have been extensively studied for older people and found to be safe and effective. However, they are not yet available in the Philippines and are quite expensive.

Here are the characteristics of these new sleeping pills:

Ambien induces sleep quickly but causes grogginess if you sleep less than eight hours. It is not approved for long-term use. A new formulation, Ambien CR, a time-release pill, is approved for long-term use.

Sonata wears off in about four hours. It can be taken during the night if you have problems staying asleep.

Lunesta will help you fall asleep quickly but should only be used when you expect to get eight hours of sleep. Otherwise, temporary memory loss may occur. It should not be taken right after a heavy meal. It is approved for long-term use.

Rozerem is not a controlled substance, although manufacturers warn that its use increases the possibility of addiction or abuse. Remelton helps with sleep-onset problems but is not recommended for restarting sleep if you wake up during the night.

So, which one should you take? Much depends on your specific problems. Having trouble falling asleep is one problem, having trouble staying asleep is another. Working out the proper dosage may take time. Some people can reestablish their sleep cycles fairly quickly on small doses. But if sleeping pills are needed for long-term use, there’s no reason not to prescribe one of the newer sleeping pills.

Talcum Powder

Q. Is it safe to use talcum powder for my baby? Can I use it for myself after my shower? J. O. Cebu City.

A. The evidence is unclear. Talc, also known as soapstone, is a soft white mineral used in a range of cosmetic products, including body powders. Though some natural talc deposits may contain asbestos, a known carcinogen, cosmetic powders are supposed to be asbestos-free. Nevertheless, studies suggest they may still raise the risk of ovarian cancer.

The main concern is that when used in the groin area, talc particles may migrate through the genital tract to the ovaries. In a study in the International Journal of Cancer in 2004, for example, investigators noted a slight increased risk of the most common form of ovarian cancer in women who used talcum powder. But overall, the research has yielded contradictory or inconclusive findings.

Lung disease, including lung cancer, is another concern – but primarily in workers who breathe in large amounts of talc dust particles during mining and processing. A few cases of serious lung problems have been reported from chronic overuse of cosmetic talc products.

Bottom line: To be on the safe side, don’t use talcum powder. If you want to use it on occasion, do so only in a well-ventilated room, limit how much you apply, and don’t use it in the genital area. As an alternative, consider switching to cornstarch-based products.

Don’t use any powder on babies. If inhaled, they can cause lung damage and breathing problems, according to the American Academy of Pediatrics. Hospitals have also abandoned the use of talc powder, such as when putting gloves on the hands or as a medium during therapeutic massage treatments. It is no longer used in nurseries. Modern hospitals, like the Asian Hospital and Medical Center, has a specific memo to its staff on the dangers of the use of talc powder in a hospital setting.

Immunization Guidelines

Q. My doctor has asked me to get immunization for certain diseases. I am 45 years old and so I thought I was through with all my vaccines. What’s the real score here? T. M. Laoag City.

A. Immunization is not just for children and travelers and it’s not just about getting a flu shot. Adults are vulnerable to complications caused by many diseases that vaccines can prevent. Women, in particular, benefit from vaccinations. They live longer than men, so they have a greater chance of being exposed to infectious diseases in later life. They’re also more likely to work in health care, education, and child care, where they’re at risk for whooping cough (pertussis), hepatitis B, measles, mumps, rubella, and chicken pox (varicella), as well as influenza.

In October 2005, the US Advisory Committee on Immunization Practices (ACIP), which makes recommendations to the Centers for Disease Control and Prevention, issued an updated schedule of adult immunizations (see Table). Adults ages 19-64 would be vaccinated with a newly formulated tetanus-diphtheria-pertussis (Tdap) vaccine. (Tdap would replace the current tetanus-diphtheria, or Td, vaccine.)

Please take time to look at the Table, which lists the latest available recommendation on the schedule for adult immunization. In the footnote, you also have a website address that provides information about immunizations related to travel.

Remember, an ounce of prevention is worth a pound of cure!