I have had insomnia for years, which I put down to the menopause. Now I’ve come across research that suggests interrupted sleep in middle-age increases the risk of Alzheimer’s. What should I do? I am 62.
Lindsay Evett, Aslockton, Notts.
You are correct — insomnia can be a feature of the menopause in some women.
More common symptoms include night sweats, fatigue and anxiety. These are all due to the decline in oestrogen levels seen at menopause.
In terms of your concern that sleep deprivation increases the risk of subsequent dementia, this appears to be what we call an association, rather than a causal relationship.
Cause is where there is a proven link — for example, osteoporosis. The thinning of bones causes them to be less dense and mechanically weaker, so when a person falls over, their hip is more likely to break — so osteoporosis is causal of hip fracture, given the added provocative factor of a fall.
In this case, we do not know if sleep deprivation directly causes dementia, or whether the factors that cause dementia — which are multiple, ranging from genetics to smoking — are also factors that contribute to poor sleep quality.
Insomnia can be a feature of the menopause in some women (stock image)
Or it could be that the factors that cause insomnia, such as mood disorders or chronic pain, may also be involved in the brain deterioration and decline seen in dementia.
There is much research being conducted into this, though I fear it will be some years before we have any practical insights.
But what’s important to note is that oestrogen is a key hormone for the brain. Oestrogen is known to affect the brain in different ways. For example, its role in the hypothalamus — the part that controls body temperature — is thought to explain hot flushes.
Studies also suggest oestrogen helps increase the number of connections in the hippocampus, important for memory and certain types of learning, which could explain why the menopause can lead to memory problems.
It may also explain why Alzheimer’s is more common in women, as oestrogen seems to play a role in protecting the brain from damage.
This leads me to believe you need oestrogen treatment — in the form of hormone replacement therapy (HRT). You say you are taking HRT, but do not specify which. There are many types and no one size fits all.
I would suggest that you need to see your GP to ensure your HRT contains sufficient oestrogen.
It may be that you are receiving oestrogen, but the dose is not high enough and insufficient levels are reaching your brain tissue.
This may be due to the bypass effect: when medicines taken orally then go through to the liver, a significant proportion of the dose is lost.
You need to take oestrogen topically — that is, in patches or gel, foam or cream forms, which allow oestrogen to pass directly through the skin into the bloodstream, bypassing the liver.
This is likely to protect you from any potential damage to the brain tissue seen in menopause, and you may find it helps with your insomnia.
You ask in your longer letter whether the hormone progesterone can help with sleep, but I cannot find any scientific evidence for this — only anecdotes.
As well as topical oestrogen, you might like to consider a magnesium supplement: studies have confirmed that this improves insomnia in older people.
I would also suggest seeking a referral for cognitive behavioural therapy (CBT), where you will talk through your problems with a therapist and learn strategies to overcome faulty thinking and behaviour that may be contributing to your sleep disturbances. This takes time, but it is proven.
My friend’s wife was diagnosed with breast cancer and told she needed a mastectomy. However, she searched online for a second opinion and found a ‘specialist’ who told her she needs to give up sugar — apparently, it feeds cancer. Can you see problems with this sort of treatment?
Arthur Bedford, King’s Lynn, Norfolk.
This is a worrying turn of events. Anyone in medical practice would be supportive of a patient receiving a second opinion, but the advice given to your friend’s wife is unscientific and potentially harmful.
You do not make it clear where she found this advice, but I assume it is an alternative practitioner, as the recommendation is not recognised or effective.
In fact, I would go so far as to say this advice is fraudulent. There is no evidence that excess sugar in the diet can ‘feed’ cancer cells and cause them to grow. This is a myth.
Most importantly, at this stage of her condition, it is wrong to opt for a second opinion from a non-medical practitioner who is making claims that are unscientific and unsupported by medical studies. I fear that she is being exploited as a vulnerable patient, when there are many proven and established treatments for her.
Breast cancer is not always treated by mastectomy. Many patients undergo a lesser procedure known as lumpectomy, where the cancer and a border of healthy tissue is removed. This is often followed by radiotherapy to the site where the lump was removed, but is far less mutilating than a mastectomy, and studies have shown this regimen is as effective in clearing malignant cells.
Examination of the tissues will inform the subsequent treatment, based on which will work best for the individual’s type of breast cancer (treatment may include chemotherapy, for instance).
We know that healthier diets and lifestyles are associated with a lower risk of cancer, and as part of this healthier lifestyle, lower sugar consumption is recommended.
But that doesn’t mean eliminating all sugar will inhibit cancer.
There is no evidence that cutting out sugar completely would lower the risk of getting cancer, or that it boosts the chances of surviving once diagnosed, and I worry that following a restrictive diet would lead to poor nutrition, which could also hamper recovery.
Sugar, in the form of glucose, is our body’s main source of energy. If no sugar is taken into the body, our cells simply create sugar by breaking down other nutrients.
In the same way, all cells use oxygen to function, and yet no one would suggest patients hold their breath to deprive the tumour of oxygen, would they?
Speak to your friend urgently. His wife should withdraw from this quackery and ask her GP for a referral for a second opinion from a breast surgeon or oncologist. She could also seek a second opinion from a private specialist, if she can afford this.
It is far safer to request that, rather than entrust the internet-derived recommendations from completely unknown sources.
By the way… DON’T fine patients for not turning up
If you ask me, the occasional patient ‘no-show’ on an extremely busy day is a relief, giving me time to see the odd one who arrives in the waiting room with no appointment, or the chance to look at the ever-lengthening list of phone calls to be returned and emails awaiting attention — or even a moment to talk to colleagues and grab a cup of tea.
But clearly, the long wait to see a GP in the NHS means no-shows are a real problem.
With 5 to 10 per cent of appointments made with GPs being missed by patients, it does not surprise me that ways of minimising those wasted slots are being evaluated. However, a recent survey that found more than half of GPs would back a proposal to fine patients for failing to attend an appointment made me see red.
A recent survey found more than half of GPs would back a proposal to fine patients for failing to attend an appointment
It is often said that nobody appreciates a service that is provided for free, and there is no doubt that, in our society, letters of thanks are but a hazy memory.
Yet the very thought of applying a fiscal punishment to teach patients a ‘lesson’, or to make them realise the value of what they have ‘abused’, is to fly in the face of all that we stand for.
We may be irritated and feel undervalued whenever a patient does not turn up for a booked appointment, but there may be many reasons for this apart from carelessness and bad manners.
There are other ways of improving attendance. I have an app on my smartphone that reminds me of appointments, and my dentist sends me a text three days before I am due to attend, plus another on the day.
Clearly, there is the software to trigger the process, so why isn’t the same happening more widely with GP appointments?
And for the elderly with no smartphone? Why, perhaps a call from the receptionist the day before an appointment might be sensible — and many do this already.