Mayo Clinic Q & A - February 2015 Archives

DEAR MAYO CLINIC: My mother-in-law has had insomnia ever since her husband died (just over one year ago). She regularly takes over-the-counter sleep aids, but I am concerned she is also depressed. Is it true that the two conditions are related? Should I encourage her to see a therapist? ANSWER: Insomnia can be a reflection of ongoing distress, and it is often associated with episodes of clinical depression following a period of grieving. But it is possible that your mother-in-law’s insomnia and the loss of her husband are not connected. It would be a good idea for her to make an appointment to see her primary care physician. That physician can assess your mother-in-law’s medical condition and, if needed, provide a referral to a mental health professional. Insomnia is generally defined as the inability to fall asleep, stay asleep or both, despite the opportunity for adequate sleep. Occasional insomnia is a nuisance, but it usually does not present significant health concerns. When insomnia persists, however, it can become a clinical problem.

DEAR MAYO CLINIC: My daughter, who is in her early 20s, was diagnosed with narcolepsy nine months ago. Her primary care doctor prescribed stimulants, but they make her very jittery and don’t eliminate all of her symptoms. Is this the only treatment available? Should she see a specialist? ANSWER: The sleep disorder narcolepsy is a lifelong condition often treated with potent medications. Because of that, it is essential that anyone suspected of having narcolepsy be carefully evaluated by a sleep medicine specialist to arrive at a diagnosis. I recommend your daughter seek testing with such a specialist. If her diagnosis of narcolepsy is confirmed, the sleep medicine specialist can work with her to create a treatment plan that best fits her needs. Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. About 70 percent of people with narcolepsy also experience a symptom known as cataplexy — sudden muscle weakness that follows a positive emotional reaction, especially laughter.

DEAR MAYO CLINIC: I know that heart disease is the leading killer among men and women, but is it true that men and women have different risk factors for heart disease? ANSWER: You are correct that heart disease is the leading cause of death in men and women in the United States. Many risk factors are the same for both genders. But there are some differences between men and women that can have an impact on an individual’s risk of heart disease. One of most significant heart disease risk factors for both men and women is smoking. Nicotine can narrow your arteries, and carbon monoxide can damage their inner lining. That makes the vessels more likely to become thick and stiff, a condition known as arteriosclerosis. Eventually arteriosclerosis limits blood flow, increasing the risk of a heart attack. Because of this, heart attacks are more common in smokers than in nonsmokers.

DEAR MAYO CLINIC: I often hear about colon cancer, but not a lot about rectal cancer. How is it diagnosed, and is it treatable? ANSWER: Rectal cancer is cancer that occurs in the last several inches of the colon, called the rectum. The primary treatment for rectal cancer is surgery and — depending on how advanced the cancer is — may also include radiation therapy and chemotherapy. If rectal cancer is caught early, the long-term survival rate is about 85 to 90 percent. Those numbers decline sharply if rectal cancer has spread to lymph nodes. Most rectal cancers begin as small, noncancerous growths of cells called polyps. Removing polyps before they become cancerous can prevent rectal cancer. That’s why timely colon cancer screening with a colonoscopy is important. Guidelines generally recommend that screening should begin at age 50. Your doctor may recommend more-frequent or earlier colon cancer screening if you have other risk factors, such as a family history of colorectal cancer.