DR ELLIE CANNON: Is there a natural remedy to tackle my dreadful insomnia?

Can you recommend natural sleep remedies? I keep waking up in the middle of the night and can’t sleep for at least two hours. I am a healthy, fit man of 52 years.

The unfortunate truth about sleep problems is that there is often no easy solution. It may take time and patience to arrive at a long-term solution that works.

If a patient wakes up in the middle of the night, doctors will first look for obvious factors interfering with sleep. This includes too much caffeine during the day, going to the bathroom at night, and exercising in the evening. Physical activity can promote sleep, but it can be overstimulating if you do it just before bed.

Sleeping environment is also very important. Doctors call this sleep hygiene, although it has nothing to do with cleanliness. It is about factors such as how dark the bedroom is, whether it is a pleasant temperature and whether it is sufficiently quiet.

Most people don’t realize that we tend to sleep better in a slightly cooler room. An eye mask and earplugs can also help, or take a relaxing bath before bed.

Avoid staring at screens (telephones or televisions) just before you want to drift off, as this can be stimulating.

Anxiety and stress are also common causes of insomnia. If this is the case, sleep problems are unlikely to be resolved unless the underlying problem is resolved.

There is a specific type of psychological therapy recommended for sleep problems. Called CBT-I, it aims to reduce the fear of not being able to fall asleep, which only makes the problem worse.

A therapist will also help patients identify and manage the thoughts, feelings, and behaviors that contribute to insomnia. Such advice should be available through local NHS psychological services called IAPT.

As for natural remedies, it may be worth trying an over-the-counter medication, such as valerian, or an antihistamine. These are not normally recommended for sleep problems, but some people find them helpful. Massage and relaxation treatments can also help.

Can you help with a very embarrassing problem? I am a fit and active woman of 76 years with no health problems. But recently I have noticed an unpleasant smell when I put my bladder. There is no pain. I am afraid to go to the toilet in a public place.

An odor after urination is usually a telltale sign of a urinary tract infection.

However, these normally cause other symptoms, including pain and the need to empty the bladder very often.

The easiest way to find out if it’s an infection is to ask your primary care doctor for a urine test.

It can be two tests. First, a dipstick test, done in the operating room, which looks for blood cells and changes in the urine that indicate bacteria is present.

Then a secondary test where the sample is sent to the lab to look specifically for bacteria.

Older women may have asymptomatic bacteriuria: Many bacteria begin to grow in the urinary tract but do not cause infection. This would be confirmed with the second test.

Changes in the smell of urine can also be the result of vaginal discharge. This is more likely after menopause, due to changes in the vulval tissues.

Certain medications, such as vitamin supplements or penicillin, can also change the smell of urine – check with your pharmacist.

Being dehydrated can be a factor, as can eating certain foods, including asparagus.

It’s worth drinking more water and seeing if that solves the problem.

I recently had Covid and since then I have excruciating pain in my buttocks and thighs. The pain and cramps have gotten better, but I still have to take painkillers daily to deal with it. Is there anything that will speed up my recovery? I’m 77.

Viruses are known to cause a range of problems, including those affecting the muscles. This sounds like reactive myositis – inflammation in the muscles that develops after an infection like Covid.

Typical symptoms are weak, sore muscles that feel tender. The thigh muscles are often affected, as are the shoulders or hips.

Muscle aches and pains are one of the more widely recognized symptoms of long-term Covid.

Experts recommend activities such as stretching and yoga to improve flexibility, as well as strength training to build muscle.

Pacing yourself is an important part of recovery. Start with a low activity level before building up gradually.

Myositis occurs as a result of the immune system’s effort to fight the virus, as the body’s fighting cells cause inflammation in the muscles.

It can also develop as a chronic autoimmune disease. It could be a coincidence that it happened at the same time as Covid, or the virus may have caused it.

If symptoms have persisted for months, it may be worth asking your GP for blood tests to confirm the diagnosis and look for muscle damage.

Steroid tablets are often used for the chronic type of myositis, to reduce inflammation in the body.

Are you one of the growing army of booster rejecters?

Have you had your last Covid booster yet? Since the beginning of September, anyone over 65 has been eligible for an extra dose to protect themselves against the inevitable winter wave.

Health professionals, pregnant women and people who are very vulnerable to Covid can also have one. But apparently many people in this group still have theirs.

I’ve heard from some that they don’t want another shot because they’ve had four or five now, and others haven’t even been invited.

It doesn’t bode well as we have the rest of the over-50s to get through, who will be called up in the coming weeks.

The extra boost of protection is crucial, with a double whammy from Covid and flu expected to beat the NHS this winter. I’ve officially been given a boost – and all it cost me was a slightly sore arm for a few days.

I want to know if you have had your booster yet. And if not, why not? Write and tell me.

Cheap drugs miss the mark

Are you familiar with the drug Humira? Or adalimumab, to use the generic name.

It is one of the most commonly prescribed drugs and is used to treat conditions involving the immune system, such as rheumatoid arthritis and bowel disease.

But Humira is branded, making it blindingly expensive, so since 2018 the health service has been offering patients generic, cheaper versions of the drug called biosimilars.

But I’ve heard that some patients have found the cheaper versions to be less effective. A friend, a man in his fifties with severe arthritis, has been told he cannot return to Humira because it is too expensive, leaving him in terrible pain.

I want to know how you are doing with the switch. Please write to me and tell me.