Treatments such as sleep hygiene and cognitive-behavior treatment are recommended fro insomnia.
Dear Dr. Roach:I am 90 years old and can’t sleep at night. I have tried taking two or three times the dosage of most over-the-counter drugs to no avail. A prescription drug also didn’t work. Is there an alternative?
D.J.
At the age of 90, you need careful consideration about treatment for sleep troubles as some of the common treatments that aren’t too bad for young adults can lead to significant problems in older adults.
First off, the OTC sleep medications, which are most commonly diphenhydramine (Benadryl), are not great choices for anyone. I especially worry about them because they suppress the most important types of sleep, cause confusion, and increase the risk of falls and motor vehicle accidents. When taking them above the recommended doses, these side effects become more likely.
Prescription medications also have risks including tolerance and dependence. In older people, cognitive impairment and delirium are not uncommon. Most of the advertised prescription sleep medicines are inappropriate for older adults. Accordingly, nonmedication treatments such as sleep hygiene and cognitive-behavior treatment for insomnia are preferred over medication.
Dear Dr. Roach:My wife, 78, recently underwent a lithotripsy procedure, along with a stent being placed in her urinary tract. She had several UTIs in the recent past. Within 24 hours of the procedure, she had convulsions and could not stand up or support her weight. I recognized that this reaction was due to a UTI since it has happened in the past. Upon being hospitalized, she was diagnosed with a UTI and sepsis.
Should her urologist have scheduled a urine test prior to the procedure to make sure that she did not have an infection? After confronting her urologist about this, he said the test is normally unnecessary. What do you think?
R.S.
It is standard procedure to perform a urine test prior to urological procedures such as lithotripsy, which is a procedure to break up stones. At least 9% of such people will have a urine infection. People with stents are at a higher risk, as are people with large stones.
The American Urological Association recognizes that serious complications, including sepsis, may result from treatment if a urine infection is present. It sounds like her urologist was in the wrong here if the facts are as you presented them.
Dear Dr. Roach:We have a hot tub on our deck. I understand the recommended time to spend in the water is about 15 minutes. We keep it between 37-38.5 Cs. My 77-year-old husband sometimes stays in the tub for 90 minutes or even up to 120 minutes. Is this OK?
K.M.
If your husband has no symptoms, it’s unlikely to cause harm. With hotter hot tubs, often around 40 C, many people will become dizzy or lightheaded as the blood vessels in the skin open up and the volume in the heart goes down.
After 90-120 minutes, there is a danger of hyperthermia. Most people will naturally learn to keep part or most of their body out of the hot tub if they feel too warm. Some older people have a hard time recognizing this.
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