Diplomate, Board Certification of Emergency Medicine
More letters. I was asked about sleep disorders. This problem
can be first broken down into fatigue -- meaning tired, but
weak -- and sleepy which means more along the lines of losing
contact with the surroundings and even falling asleep during
People who are tired and fatigued can have anemia,
hypothyroidism, B12 deficiency or other diseases and are best
worked up by an internist. Mental fatigue can be due to
stress, overwork and depression. We have spoken about this.
This is best worked up by a psychiatrist.
People with daytime sleepiness may have a movement disorder
when they sleep, which affects sleep quality or Pickwickian
Syndrome, where overweight people may even stop breathing in
the middle of the night and they wake up with a start. These
people need to lose weight, but in the meantime, they sleep
with machines that blow air in under pressure to keep
breathing passages open. This last group is best evaluated by
a sleep specialist with a sleep lab. Many people in the field
do not believe there is such a thing as chronic fatigue
Treatment for mental fatigue responds well to
antidepressants. Overwork is best treated by rest. Since the
elderly are poor sleepers on average, here sleep aid may be
indicated. As well, the British Medical Journal also
recommends the use of sleep aids for a few days after a long
trip to help against jet lag. Melatonin is a natural aid for
sleep especially for jet lag. It may work, but be sure the
synthetic brand is used. Natural sources are from cow brains
which may not be kosher, and may spread brain viruses such as
mad cow disease.
In Israel we have Nocturno and Stillnox (Ambien in the USA).
These medications are non-addicting and short acting. The
first has a bad taste and the second may cause hallucinations
in the elderly. Bonserin and Trazadone (Desyrel) are
antidepressants. They work, but we have much more effective
medications. Bondormin is a benzodiazepam which is the same
family as valium. It is a tranquilizer as well. It may be a
problem of dependence -- use sparingly. Hypodorm works well,
but it is illegal to bring this drug into the USA even if it
is for personal use. It causes amnesia and it has been used
for criminal purposes. My thanks to Dr. Yaron Dagan, the head
of the Sleep Lab at Tel HaShomer.
I would like to spend a little time on another problem that
we have not spoken about. Check any Jewish periodical and it
is full of weight-loss schemes. Many if not all are
We have never discussed the opposite: those who can eat
anything and never gain a kilogram. This can be an acquired
problem, especially in cancer and hyperthyroidism. But most
of the time, these types of people have parents of the same
type. Little can be done, and eating a lot to try to gain
weight can be dangerous. Be happy with your lot. Write me in
care of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. We discussed in this column antidepressants, and
Seroxat is one of the best in the business. A newer
antidepressant, it combines effectiveness with safety and a
quick return to normal living.