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

I have been on the sleeping pill zopiclone for seven months and am wondering if I should come off it. I sleep well, but I’m starting to get a headache. Do you have any advice?

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

Longer use can lead to dependence. People may find they cannot sleep without it and suffer from side effects such as brain fog, poor memory, numbness, and even anxiety and depression.

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

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

Some patients tell me they feel their heart beating faster or their old sleep problem is coming back – but this is just withdrawal. It’s important to talk to your doctor 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 try.

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 exacerbate insomnia.

For example, relaxation therapy or sleep restriction are used. Sleep restriction is where the patient is encouraged to limit their time in bed. They go to bed and get up at a set time, with a shorter time frame in the beginning.

It is quite a complicated process and a doctor or therapist can help you with this. Or you can try an app like Sleepio.

Sleep hygiene is often talked about. It means creating the best possible environment and mindset for sleeping with ideas like a technology-free room and no exercise before bed. This will not cure your insomnia, but it is also an important help.

After tripping over a broken paving stone 18 months ago and breaking my shoulder and arm, I was diagnosed with moderate osteoporosis. I am 72 and have always eaten well and exercised. I’ve been recommended a drug called zoledronate but I’m concerned as I’ve read it can cause some pretty nasty dental problems and I recently had an extraction. What should I do?

Osteoporosis is the thinning of the bones making 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 problems.

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

Osteoporosis is diagnosed with a DEXA scan. The result is given as a score that translates into different stages of bone thinning.

Whether treatment is recommended and what that treatment is depends on these results and a personal risk score calculated by a doctor, known as the fragility fracture score. If you have already had a break, this means a higher score, but it also depends on other factors such as age and family history. Treatment includes diet and exercise. It’s vital to get enough vitamin D and calcium, both needed for healthy bones, as well as performing weight-bearing and muscle-strengthening exercises to support your bones.

The Royal Osteoporosis Society’s website (theros.org.uk) contains helpful exercise guides and dietary advice.

Medication is important to strengthen the bones and there are different types of medications, including HRT, that may be appropriate for some women in this case. All medications have side effects, and the dental complications of some osteoporosis drugs are important to weigh if you need dental work. If you have had any dental problems, it is important to let your doctor or nurse know so they can determine the best treatment.

I have just returned from a holiday in Spain and started experiencing 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 am 71 and active. Are there any medications I could take? When it flares up, it is very painful and uncomfortable.

Such swelling is known as edema and while it may look unsightly and feel uncomfortable, it is generally harmless if all tests are normal.

Sitting for long periods of time can slow down the movement of blood from the lower extremities to the heart. This allows fluid in the blood to leak out of the veins and into surrounding tissues, causing the swelling.

Movement of the muscles in the legs and feet helps to push blood more efficiently through the veins back to the heart.

Edema is worse for anyone with heart or vascular problems, so doctors do heart tests and other scans to make sure everything is okay. You can consider special socks for the plane. Compression stockings put pressure on your legs, mimic the muscles and promote circulation. These are measured especially for you and you can try different strengths and lengths to see what works and is comfortable for you.

We sometimes prescribe water tablets – diuretics. It may be something that can be taken on a short-term basis to avoid these troublesome symptoms on vacation.

Did the hospital send you home uncared for?

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

A few days after his admission, despite being practically unconscious after breaking his hip, a hospital worker called to say he was “ready to come home.”

His wife, of course, agreed. She asked if there would be help. “Someone is coming to judge,” she was reassured. A care package would then be provided – a bed downstairs, a changing table and some help. But that never happened.

Fortunately, she gathered friends to get a bed in the living room. After a few days of calling, the GP arranged for a bedpan – but she still couldn’t get hold of anyone from the hospital.

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

If you’ve been in this situation, I’d love to hear from you. Write me at the above address.

Heart attacks also affect women

I found myself getting annoyed with an image posted on social media by the NHS’s Instagram account this week.

The photo was of an overweight man clasping his hands around his chest, followed by part of a heart health campaign designed to help people recognize the signs of a heart attack. But we need to stop presenting heart attacks as a men-only problem.

It is common knowledge that heart attacks often remain hidden in women because they are believed – among patients and some doctors – to be unique to men. It means women are slower to receive vital treatment and are more likely to die from a heart attack.

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