Dear Doctor: My sleeping pills don’t work anymore. Where can I find help?

DEAR DR. ROACH: I’m a healthy, active 70-year-old woman. I have a sleep problem that affects everything in my life, because I’m tired most of the time. I started taking Lunesta about 20 years ago. I had teenagers and a stressful job at the time, and I just needed help sleeping. The doctor promised me that it was not addictive. Well it is! I’m now retired and the kids are gone so there’s really no reason why I can’t sleep without medication, but I can’t live without it. I take it at bedtime, and on good nights I get around four hours of sleep, sometimes less. It doesn’t seem to be doing its job, but on the other hand, I can’t stand it. If I don’t take it or try to cut it in half, I don’t sleep at all.

My GP is not helpful. He says I should keep taking it. He actually increased the dose to 3mg because he said 2mg no longer worked for me. I’ve tried meditation, exercise, diet changes, not eating before bed, eating before bed, magnesium, melatonin, etc. Nothing works. I feel like I can’t live with the pills or without them. I’m torn between the lesser of two evils, which is taking sleeping pills for the rest of my life or living with constant bad sleep. Do you have any suggestions? What type of professional should I consult to help me fall asleep? — AS

ANSWER: You should consult a specialist in sleep medicine. Medications are not the main treatment for stress-related insomnia: your story shows that these medications, while they may be appropriate for occasional short-term use, are not good long-term approaches to the disorders sleep for most people.

The most appropriate treatment is cognitive behavioral therapy for insomnia. Medications are sometimes given with the aim of gradually reducing them over several weeks. It is high time to stop these 20 years of ineffective medication. In most cases, treatment is started first and then the drugs are gradually tapered off over the months. Your sleep specialist will give you instructions for a slow reduction.

DEAR DR. ROACH: I just read your advice on when to get the flu shot. I always got my flu shot around October-November, until the last two years when I got it in August-September. The pharmacy offered it to me when I went to get medicine. I decided to get it early for personal reasons. If the vaccine loses its effectiveness, can you receive another vaccine in the spring? I’m over 65, so I get the “senior” dose. My husband and I strongly believe in respecting science and have always received vaccines; it must come from being children of the ‘polio era’. — BV

ANSWER: No, we do not recommend a second flu shot in the spring, as the flu season usually ends at this time. The flu vaccine you received in August covers you at least until March. There really is no benefit to a second dose.

It’s possible this year will be different – we just don’t know – but if the recommendations change, I’ll cover that in this column.

I have found that those who have lived through polio have a much better appreciation of the benefits of vaccines (in general) than those who, until COVID, had never seen a devastating pandemic.

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Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to [email protected] or mail to 628 Virginia Dr., Orlando, FL 32803.

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