Friday Q&A: insomnia; full-body MRIs; aging & acceptance; & "normal" vs. worrisome pain

You ask the best questions!

ICYMI 👉

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Question #1 (on insomnia) is free for all subscribers. Questions #2-4 (on full-body MRIs; aging & acceptance; & defining “normal” pain) are for paid subscribers only. If you would like a paid subscription but it’s not in your budget, please message me directly!

Click here to submit your questions (about anything) for future Q&A posts!

Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

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QUESTION #1: INSOMNIA

Hi, I struggle with insomnia sometimes due to anxiety and my mind whirring too much! So, I use Xanax for nights that I just cannot relax. But my doc wanted me to switch to Trazodone. Neither medication is great. This is not an everyday problem but it feels harrowing when I get into a weird insomnia phase. Do you have any thoughts on what to do? Thank you for considering my question. You are a blessing and great resource!

-Need for Sleep

Dear Need for Sleep,

Sleep is the “glue” for our whole health, but getting it is easier said than done! I commonly hear from patients that they turn to sleep aids like Nyquil, Unisom, or even a glass of wine to quiet a noisy brain at bedtime. The problem with these stop-gap measures is that they produce a state that is closer to sedation and not actually restorative sleep. They can also be addictive and can cause unpleasant side effects like nighttime eating and fuzzy-headedness upon awakening. The same can be true for prescription sleep aids like Xanax and Ambien. Ambien can also negatively affect cognition over time. I generally prefer Trazodone because it is safer for long-term use compared to Xanax (or its cousins, Clonazepam or Ativan) which can be particularly habit-forming. While prescription medications can certainly be appropriate for some patients, it’s important to remember that everything we put in our bodies—prescription or not—carries risk and reward.

The best medicine is optimizing the environmental, behavioral, and psychological “ingredients” for sleep. People tend to sleep best when:

• their bedroom is dark, quiet and cool—and when it’s free of pets or pesky bedpartners (i.e. try using earplugs, eyeshades, or noise machines as needed). 

• they develop a bedtime routine in order to naturally wind down. Try ditching screens an hour before bedtime and instead writing in a journal, using a meditation app like Calm, Headspace, or Insight Timer; or taking a warm bath and listening to calming music.

• they are managing their stress and anxiety. Sleep comes a lot easier to people who exercise regularly, actively process their worries (i.e., with a therapist, friend, or coach), and ask for support for emotional distress.

Some of these items—like ear plugs—are quick and easy. Others—like setting an electronic curfew—are easier said than done. And others—like reforming a snoring bed partner—may be close to impossible. 

So just do the best you can. And remember that this is a process. For example, even if you can only manage a 15-minute window of screen-free time before bed, it’s well worth trying. If you notice it helping just a wee bit, you might try experimenting with it further. You might even delete an over-stimulating app or two—and find yourself less irritable and more relaxed on awakening. 

Photo by Mpho Mojapelo on Unsplash

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QUESTION #2: FULL-BODY MRIS

Is there any utility to full-body MRIs as a health screening tool? I have seen a lot of health and wellness influencers promote this but haven’t seen any evidence.

-Angelica

Dear Angelica,