Archive for April, 2017

Long-term use of antihistamines to treat insomnia is not advised

April 23, 2017

From Ask the Doctors in the Conway Log Cabin 4/23/17
by Robert Ashley, M.D.

Dear Doctor: I’m leery of sleep drugs, so I’ve been taking Benadryl to help me sleep. Now I read that it should be taken only for a limited time. What’s the story on this drug?

Dear Reader: Diphenhydramine HCL, or Benadryl, is a sedating antihistamine. The medication has been used since 1946 for allergies, but because it is sedating, or sleep-inducing, people have also used it to help them sleep. Unlike the allergy medications Claritin, Zyrtec or Allegra, this medication blocks histamine receptors in the brain. Histamine is necessary to promote wakefulness, motivation and goal-directed behaviors; when the receptors for histamine are blocked, drowsiness occurs. Many companies have marketed diphenhydramine and doxylamine (another sedating antihistamine) for insomnia under different brand names.

Researchers have conducted many studies of diphenhydramine for insomnia, but most have been small. One of the larger studies looked at individuals with an average age of 44 years who had mild insomnia. In this study, people either took diphenhydramine or a placebo. The diphenhydramine group switched to a placebo after two weeks. The participants kept diaries of how long it took them to fall asleep, their total sleep time and the number of times they awoke.

Researchers found no difference between the drug group and the placebo group in the time needed to fall asleep. However, sleep quality improved significantly among those taking the drug. Total sleep time also improved with diphenhydramine, but only by 29 minutes. The authors did not find significant adverse effects and did not find rebound insomnia when the participants stopped diphenhydramine. The authors concluded that, for the short term, the drug does have benefit in treating insomnia.

As for the merits or risks of taking the drug for more than two weeks, there are no good long-term trials of diphenhydramine, and prolonged use raises the potential for problems. Further, two weeks of using sedating antihistamines can create some degree of tolerance to their sleep-inducing effects, so their effectiveness may wane.

In its guidelines for sleep medications, the Journal of Clinical Sleep Medicine does not recommend the use of antihistamines for chronic insomnia. Sedating antihistamines can lead to dry mouth, constipation, retention of urine in the bladder, blurred vision and a drop of blood pressure upon standing.

Further, diphenhydramine’s half-life, the time it takes for the drug to lose half of its activity, is nine hours in adults, but 13.5 hours in elderly individuals. That means the drug is still having effects long after one awakes. Sedating antihistamines also can cause grogginess, confusion and memory loss. This is especially concerning in the elderly.

I would re-evaluate whether diphenhydramine is really helping you sleep. You should also consider whether the medication is causing any side effects. Other medications can be used as sleep aids, but the best move, especially for the long term, is to improve your sleep hygiene, such as using the bed for sleep and not for watching television.

If you have trouble doing this on your own, a professional who specializes in sleep therapy might be able to help. Though sleep therapy is a relatively new field, it has shown significant benefits.

Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.

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Making war on the people

April 2, 2017

Article from the Arkansas Democrat Gazette by Philip Martin

We don’t need our best and our brightest involved in politics; genius should be out curing cancer and writing novels that sound the black depths of the human heart. It doesn’t take any particular talent to serve in a state legislature or even in Congress (Jefferson imagined an amateur government might be run by yeoman farmers and tradesmen); they just need to be reasonably honest and, as Harry Truman said, “work in the interests of the common people and not in the interests of the men who have all the money.”

Governance is more like medicine than music. The prime directive of its practitioners should be to do no harm to the body politic. Certainly there are times when tough measures are called for, but any scars that are inflicted should be in service of achieving a greater good. We might disagree on what actions our elected representatives should take at any particular point in time, but we have a right to expect that they govern with a degree of empathy for the folks back home.

Ha.

We all know an individual American’s worth directly correlates to the bank account size. Money buys access, money changes minds. Money warps reality in ways that are absurd until you consider who stands to benefit from the absurdity. Poor people just don’t matter to some of those who are supposed to protect us. Our government is free to make war on the poor and powerless.

Most of us have become something less than citizens. We are more like crops to be harvested or resources to be exploited. Fictive personalities have been granted a better set of rights than you have because those stateless corporations have the ability to write much bigger checks to the people who pass laws than you can. So these corporations have been given the right to sell information they’ve surreptitiously gathered by spying on you.

You might think that your information belongs to you. Too bad. You’ve been outbid.

At the same time, a lot of these lawgivers have decided that the privacy of the world’s most public self-proclaimed billionaire matters more than national security. Despite promises to comply with decades of electioneering tradition by releasing his tax returns, despite real questions about what foreign entities might hold the note on his gilded existence, our president won’t tell us about his finances.

Because, as he’s said, he’s president and you’re not.

And if you want quality health care, prepare to pay for it. Or get yourself elected to Congress. Because these people are beholden to super-citizens like insurance companies and pharmaceutical firms. Because they have bigger things to worry about than whether you can afford to get sick. (Besides, if you amounted to anything, you’d have plenty of money to pay your doctor. After all, do you really need an iPhone or a curved-screen TV?)

The world is a hard place and you probably shouldn’t expect these denizens of marble halls to help you out. Because they’ve either got theirs or are in the process of getting same. And because you’re dumb enough to let them operate as they do, to let them get away with not doing the right thing.

To be fair, the world is a complicated and nuanced place and it’s sometimes hard to decide which course is the right one to take. So it’s not surprising that human beings might look to professional explainers, for people who can make the world seem simpler. While there are plenty of people willing to try to do this in exchange for your attention (which they can sell to advertisers), most of them are guessing just like the rest of us. And worse, their guesses are incentivized by third parties who have their own versions to propagate. Most of us prefer to hear stories that reassure us and flatter our sense of ourselves as decent and smart. Any problems we have are most decidedly not our fault—they’re the fault of whoever the professional explainer finds convenient to demonize.

Some of us understand this and take into consideration that the talking heads on television—whether they’re paid by MSNBC or Fox or by the taxpayers—are entertainers whose mission is to convince us that what their corporate sponsors would do is precisely the best thing.

This is how they get you to vote contrary to your own interest.

That’s your right, and it’s sometimes a noble thing. I can think of many things I would gladly support with higher taxes. You probably can too—most of us want a government able to protect us from threats we can’t handle on our own. Most of us would prefer old people not starve, that sick people not be denied medical attention.

Most of us believe there are some legitimate functions of government. A lot of us would prefer a government that doesn’t overly intrude on our daily lives.

I don’t think it’s wise to put much trust in government. Not because everyone who seeks or holds office is venal and corrupt but because it is so easy for human beings to rationalize whatever course they’d prefer to take. For cultural and psychological reasons, lots of us desire firearms; so someone provides the rationale that lots of firearms somehow makes society safer.

For cultural and psychological reasons, lots of us feel uncomfortable around people whose sexual identities seem less rigidly defined than our own; so someone provides the rationale that these people are disturbed and morbid, that they represent a threat to the way others would live.

For cultural and psychological reasons, some of us would prefer not to deal with vocabulary and nuanced argument; so someone provides the rationale that feelings trump facts and that there’s something unreliable and effete about thinking too much about anything.

This is why so many of us believe things that are demonstrably untrue; because someone has cynically supplied us with a set of talking points with which we can argue any absurdity. They’ve set us against each other, to squabble about what scares us most. We’re playing their game.

Maybe they’re smarter than we think.

pmartin@arkansasonline.com

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