DR ELLIE CANNON: I’ve taken sleeping pills for months… Is it time I gave up?

I have been taking the sleeping pill zopiclone for seven months and am wondering if I should stop. I sleep well but started having headaches. Do you have any advice?

Zopiclone is a Z drug – the other is zolpidem – and these should only be used for a short time, perhaps a few weeks.

Taking them longer can lead to addiction. People may find that they cannot sleep without them and suffer from side effects such as brain fog, poor memory, numbness, and even anxiety and depression.

We also know that a tolerance sets in so that over time people have to use it more and more.

Anyone taking a Z drug for longer than about a month should reduce their dose slowly due to the risk of withdrawal effects. These can include anxiety, shaking, sweating and nausea.

Some patients tell me they feel their heart racing or their old sleep problem comes back – but it’s just withdrawal. It is important to talk to the GP to make a plan on how to quit.

We often do this over a period of weeks or months to make it as comfortable as possible. It may take more than one attempt.

For long-term sleep problems, the recommended treatment is CBT-i, a specific form of cognitive-behavioral therapy that addresses the thoughts and behaviors that cause and worsen insomnia.

For example, relaxation therapy or sleep restriction is used. Sleep restriction is where the patient is encouraged to limit their time in bed. They go to bed and get up at fixed times, with a short window at departure which is increased.

It’s quite a complex process and a GP or therapist can help you with it. Or you can try an app like Sleepio.

Sleep hygiene is often mentioned. This means creating the best possible environment and mindset for sleeping with ideas like a tech-free bedroom and not exercising before bed. It won’t cure your insomnia, but is a big help at the same time.

After tripping over a broken cobblestone 18 months ago and fracturing my shoulder and arm, I was diagnosed with moderate osteoporosis. I am 72 years old and have always eaten well and exercised. I have been recommended a drug called zoledronate, but am worried as I have read that it can cause some pretty nasty dental problems and I recently had an extraction. What should I do?

Osteoporosis is a thinning of the bones which makes them weaker and more likely to break.

The goal of treatment is to prevent a fracture. Falls become more common as we age due to loss of muscle strength and stability and balance issues.

It can be quite serious. For example, a hip fracture due to osteoporosis will cause permanent disability in about half of those who suffer from it.

Osteoporosis is diagnosed with a DEXA scan. The result is given in the form of a score which translates into different stages of bone thinning.

The recommendation for treatment and the nature of that treatment depends on these results and a personal risk score calculated by a doctor, known as the fragility fracture score. Having already taken a break will mean a higher score, but it also depends on other factors such as age and family history. Treatment includes diet and exercise. Getting enough vitamin D and calcium, both necessary for bone health, is essential, as is weight-bearing and muscle-strengthening exercises to support your bones.

The Royal Osteoporosis Society website (theros.org.uk) offers practical guides and helpful dietary advice.

Medicines are important for strengthening bones and there is a range including HRT which may be suitable for some women in this case. All medications have side effects, and the dental complications of some osteoporosis medications are important to weigh if you need dental care. If you’ve had any dental problems, it’s important to talk to your doctor or nurse so they can find the best treatment.

Just got back from vacation in Spain and had swelling in my feet and ankles after getting off the plane. This has been happening for years, but tests show my circulation is fine. I’m 71 and active. Are there any medications I could take? When it bursts, it is very painful and uncomfortable.

Swelling like this is known as edema and although it may look unsightly and uncomfortable, it is usually harmless if all tests are normal.

When we sit for long periods, the movement of blood from the lower limbs to the heart can slow down. This allows fluid in the blood to flow out of the veins and into the surrounding tissues, causing the swelling.

The movement of the muscles in the legs and feet helps to move blood through the veins more efficiently towards the heart.

Edema is worse for anyone with heart or blood vessel problems, so doctors do heart tests and other tests to make sure everything is okay. You can consider special socks for the plane. Compression stockings apply pressure to your legs, mimicking muscle and aiding circulation. These are measured specifically for you and you can try different strengths and lengths to see what works and is comfortable.

We sometimes prescribe water tablets – diuretics. It may be something that can be taken on a short-term basis to prevent those difficult symptoms while on vacation.

Did the hospital send you home without care?

I heard an alarming story last week from the wife of a guy who was ‘thrown out’ of the hospital after a horrific fall at home.

A few days after his admission, despite being virtually unconscious after breaking his hip, a hospital worker called saying he said he “felt ready to go home. “.

His wife agreed, of course. She asked if there would be any help. “Someone will come and assess,” she was reassured. A care package – a lower bed, chest of drawers and aid – would then be delivered. But that never happened.

Fortunately, she gathered some friends to get a bed in the living room. After a few days on call, the GP arranged a bedpan – but she still couldn’t reach anyone from the hospital.

What a sad story. This scenario would fall under the discharge to be assessed. Introduced in 2016, patients who are healthy enough to leave hospital but need additional support are sent home and seen within days by an occupational health worker, who will then arrange care. It is clear that this does not always happen.

If you have been in this situation, I would love to hear from you. Write to me at the above address.

Heart attacks affect women too

I found myself irritated by an image that was posted on social media by the NHS Instagram account this week.

The photo was of an overweight man with his hands clasped to his chest, followed by part of a heart health campaign, designed to help people spot the signs of heart attacks. But we have to stop portraying heart attacks as a problem that only affects men.

It is well known that heart attacks are often hidden in women because there is an assumption – among patients and some doctors – that they are unique to men. This means women are slower to get life-saving treatment and are more likely to die of a heart attack.

Heart disease kills more than twice as many women in the UK as breast cancer. Maybe it’s time for health campaign posters to reflect that.