One of the most important steps you can take to protect yourself is to supply all of your doctors, particularly specialists, with as complete a medical status as possible, including a list of conditions you have and the drugs and supplements you take.

The following 33 drugs are considered to be potentially inappropriate for patients 65 years of age and older and may result in various adverse effects:

DRUG(generic/brand name) ADVERSE EFFECTS

• Barbiturates(Nembutol, Mebarol, Amobarbital, Butabarbital, Pentabarbital, Secobarbital) Highly addictive,more adverse effects than most sedatives
• Flurazepam(Dalmane, Somnol, Novo-Flupam, Apo-Flurazepam)May cause Central Nervous System (CNS) problems
• Meprobamate(Equanil, Meprospan 200, Meprospan 400, Probate, Apo-Meprobamate Highly addictive
• Chlorpropamide(Diabinese, NovoPropamide, Apo-Chlorpropamide)Prolonged hypoglycemia-Low blood sugar
• Meperidine(Demerol) Confusion,CNS problems
• Pentazocine(Talwin, Talwin Nx)Confusion,Hallucinations
• Trimethobenzamide(Tigan,Stemetic,Tebamide, Tribenzagan, Trimazide)Can effect motor control
• Belladonna alkaloids(Donnatal,Barbidonna)Hallucinations,confusion
• Dicylomine(Bentyl, Bentylol, Spasmoban, Formulex) Nausea,Hallucinations
• Hyoscyamine(Levsin,Hyosol, A-Spas-S/L, Cystospaz, Levbid, Levsinex Timecaps, Symax SL) Arrhythmia,dizziness,blurred vision
• Propantheline(Pro-Banthine)Arrhythmia,dizziness,blurred vision
• Carisoprodol(Soma,Vanadom)Poorly tolerated,weakness
• Chlorzoxazone(Parafon Forte DSC, Remular-S, Paraflex) Poorly tolerated,weakness
• Cyclobenzaprine(Flexeril)Poorly tolerated,weakness
• Metaxalone(Skelaxin)Poorly tolerated,weakness,sedation
• Methocarbamol(Robaxin)Poorly tolerated,weakness,sedation
• Amitriptyline(Elavil)Poorly tolerated,sedative effects unpleasant
• Chlordiazepoxide(Librium)Strong sedation,Adverse CNS effects
• Diazepam(Valium)Prolonged sedation,risk of falls
• Doxepin(Sinequan)Poorly tolerated,sedative effects unpleasant
• Indomethacin(Indocin)Adverse CNS effects
• Dipyridamole(Persatine)Sudden blood pressure drop
• Ticlopidine(Ticlid)Anti-clotting,more toxic than aspirin
• Methyldopa(Aldomet,Aldoril)Low resting heart rate,exacerbate depression
• Reserpine(Harmonyl, Serpasil, Serpalan, Novoreserpine) Depression,sedation, blood pressure drop
• Dispyramide(Norpace, Norpace CR)Could induce heart failure,other complications
• Oxybutynin(Ditropan,Ditropan XL,Oxytrol)Weakness, sedation, poor tolerance
• Chlorpheniramine(Chlor-Trimeton,Aller-Chlor, Chlorate, Chlo-Amine)Increased heart rate,disorientation
• Cyproheptadine(Periactin)Increased heart rate, disorientation
• Diphenhydramine(Benadryl,Nytol)Increased heart rate, disorientation
• Hydroxyzine(Vistaril,Rezine, Atarax)Increased heart rate, disorientation
• Promethazine(Pheneragan, Promacot)Increased heart rate, disorientation
• Propoxyphene(Darvon, Darvon-N)Highly addictive;avoid if depressed with suicidal thoughts.

Use warm water, not hot water and not cold water because hot water is hard on the hands and cold water will inhibit the sudsing of soap.

Next, you do not have to use expensive antibacterial soaps to try to kill the germs but you do need to work up a substantial lather of soap suds to dislodge the bacteria and suspend them in the suds.

While lathering your hands be sure to soap every millimeter of skin, including the thumbs, between the fingers, the backs of the hands and the undersides of the fingernails. Use a nail brush to be even more effective.

Now rinse your hands thoroughly with warm water to remove every last trace of soap suds (and germs).

Now that you have done such a great job, do not negate you efforts by grabbing the faucet tap (loaded with germs) or a door knob (especially in a public restroom). Instead use a paper towel to shut off the water and to open the door. That will go a long way in preserving the clealiness of your hands.

Last of all - teach a child how to wash his or her hands!

People with heart disease are not only at higher risk for flu than the general population but also are more likely to have a severe case and to develop complications such as viral or bacterial pneumonia. What's more, the flu can worsen coronary heart disease and trigger a heart attack.

No one is absolutely sure how the flu increases the risk of a heart attack. One possibility is that the inflamation associated with the flu can trigger the rupture of unstable plaque, leading to the formation of a blood clot that could cause a heart attack.

The strongest evidence for protection from a flu shot in people with heart disease comes from the Flu Vaccination in Acute Coronary Syndromes (FLUVACS) study. In that study, some 300 individuals who had been hospitalized for either a heart attack or a planned angioplasty were randomly assigned to receive a flu vaccine or remain unvaccinated. Over the next year, twice as many of the unvaccinated group (23%) died of heart disease, had a nonfatal heart attack, or developed severe ischemia (insufficient blood supply to the heart tissue), compared with those who were vaccinated (11%).

The American Heart Association (AHA) recommends a flu shot with the same enthusiasm as it does the control of cholesterol, blood pressure, and other modifiable risk factors for heart atacks. In a scientific advisory issued by the AHA and the American College of Cardiology heart doctors were asked to do something they may not normally do - give their patients flu shots. The Centers for Disease Control and Prevention has issued extensive recommendations pertaining to those individuals who should obtain flu shots. Go to our Home Page and click on Flu Alert for full details.

Besides getting a flu shot, two other simple measures - frequent hand washing (see Hand Washing 101) and, if possible, avoiding close contact with a flu sufferer - can help reduce the risk of catching the flu.

You can find the AHRQ card template on the Internet at ( www.ahrq.gov/qual/pillcard/pillcard.htm) and print it out or save it to your personal computer so you can customize it with your own medication instructions.

To avoid medication mix-ups, the AHRQ recommends that you describe each type of pill - its shape and color, for instance - and note any distinct markings if two pills look alike. To help with this, the AHRQ website contains images of pills that you can copy, color on the computer, and add to your pill card. You can also do this by hand.

Keep your pill card near your medications or in a visible place, like on the refrigerator or bathroom mirror.

Review your pill card with your doctor periodically to make sure that your dosages are correct and that you're not still taking anything that you do not need. Also, check with your pharmacist if you notice a change in the color, shape or size of your pills - generic medicines in particular often change appearance.

Depression coupled with hostility can be a dangerous combination. Researchers measured inflammatory proteins associated with cardiovascular disease in 316 people ages 50-70 and found that blood levels were higher in participants who showed signs of both hostility and depression. Psychosomatic Medicine, vol.70, p197.

Researchers from Finland and Canada examined 33 sets of male twins who reported divergent risk factors for back pain (e.g., one brother had a sedentary job while the other's work required heavy lifting). Despite differences in risk, many brothers both had back pain. Shared back pain was greatest between identical twins - whose DNA is the same- suggesting back pain may be due in part to genetic factors. Pain, vol.131, p272.

A recent study links strong social ties to a healthier recovery after injury. Among 674 hip fracture patients, those who'd seen or phoned a friend once a day during the two weeks before their injury were less likely to die within the next two years than patients without such frequent personal contact. Journal of the American Geratric Society, vol.56, p.1069.

Combined data from 7 studies that followed participants for up to 36 years found that obesity and being underweight (a body mass index of 18.5 or less) were associated with an increased risk of dementia. Other illnesses, like hypertension, type 2 diabetes, and cardiovascular disease, may have contributed to the elevated risk. Obesity Reviews, vol.9, p204.

Men who exercise regularily appear more likely to survive cancer and less likely to get it. According to a European study of over 40,000 men ages 45-79, cancer was 16% less common among men who exercised 60-90 minutes each day than in sedentary men. And among men who developed cancer, those who reported exercising moderately - such as walking or biking for 30 minutes per day - were 33% more likely to be alive at the end of the 7 year study than cancer patients who did not excercise. British Journal of Cancer, vol. 98, p. 1865

Psyllium fiber supplements like Metamucil do not appear to reduce inflammatory markers associated with cardiovascular risk (such as C-reactive protein) in overweight and obese adults who do not have heart disease. These findings, from a 3 month study of 158 obese and overweight participants ages 40-65, do not disprove previously reported anti-inflammatory benefits that may be derived from fiber in food.Annals of Family Medicine, vol. 6, p. 100.

C.difficile bacteria are everywhere in the environment. Three percent of healthy humans carrry it in the gut, but carriage rates in hospital patients tend to be much higher, and elderly persons being treated with antibiotics are most at risk of developing infections.These bacteria produce spores when they encounter unfavorable conditions.Transmission of infection is through the ingestion of these spores which can survive on surfaces, floors and even clothing for years and, with the exception of chlorine bleach, are resistant to many disifectants and antiseptics, including alcohol hand gel. Do not conclude that C.difficile is confined exclusively to hospitals and similar institutions. It's also a growing problem among otherwise healthy people and the problem is growing worse. It is, according to the Centers for Disease Control, responsible for tens of thousands of cases of diarrhea and at least 5000 deaths.

Some people who are infected with C.difficile never become sick, though they can still spread the infection. Others have bouts of watery diarrhea with nausea and abdominal pain and cramping. And an increasing number of persons develop severe inflammations of the colon. Complications of C.difficile infections include dehydration, kidney failure, bowel perforation, toxic megacolon and death. Signs and symptoms of this potentially life threatening illness include profuse, watery diarrhea 10 or more times a day, a fever, often greater than 101F, abdominal pain which may be severe, blood or pus in the stool, nausea, dehydration and weight loss.

Although more people with no known risk factors, including children, are contracting C.difficile infections, your risk is greatest if you:

Are taking or recently have taken antibiotics, especially ampicillin, amoxicillin,clindamycin, fluoroquinolones and cephalosporins. Other antimicrobials, including antiviral and antifungal drugs, and chemotherapy medications also can lead to increased risk.

Are 65 years of age or older. Older adults have a disproportionately high infection rate.

Have a serious underlying illness or weakened immune system.

Are or have recently been hospitalized, especially for an extended period. In general, larger hospitals have higher infection rates than do smaller hospitals.

Live in a nursing home or longterm care facility. Often the infection spreads when patients are transferred from hospitals to other facilities.

Have had abdominal surgery.

Have a chronic colon disease such as inflammatory bowel disease or colorectal cancer.

Take prescription or over-the-counter antacids. By reducing stomach acid, these drugs may allow C.difficile to pass more easily into the intestine.

Have had a previous C.difficile infection.

Among the steps you can take to stop C.difficile from infecting you is to take antibiotics only when absolutely necessary and, even then, ask your Doctor to prescribe one that has a narrow range that you take for the shortest period of time so as to disrupt intestional bacteria the least. You my also consider Probiotic Supplements which help replace beneficial bacteria that antibiotics destroy. Only Saccharomyces boulardi has proved effective in C.difficile infections however. Last of all, the simplest and one of the best preventatives is to wash, wash, wash your hands! See Hand Washing 101 article on this same Health Alerts Page.

If you've been diagnosed with heart failure or have been told that you may be at risk, it's important that you work with your doctor to develop a treatment plan that addresses your needs and the severity of your disease. The two basic components of most treatment plans are medication and lifestyle changes.

The best way to respond to heart failure is to educate yourself, listen to your doctor's advice and pay attention to what your body is telling you.

Warning signs of heart failure tend to develop gradually. Because they come on slowly, in the disease's early stages, signs and symptoms may be missed or attributed to another condition. Here are some of the most common signs and symptoms of heart failure and some of what causes them.

Shortness of Breath- Because the heart can't pump blood fast enough, it "backs up" in the veins that connect the lungs to the heart causing fluid to leak into the lungs, producing shortness of breath, especially when lying down.

Cough or Wheezing-Similar to shortness of breath, the leaking fluid into the lungs produces a cough or wheeze.

Swelling of Body Tissues-When blood flow back to the heart slows, fluid builds up in tissues such as the lungs, feet, legs and abdomen. The kidneys also become less efficient in disposing of water and sodium. making tissues more susceptible to fluid retention.

Weight Gain- Fluid retention causes weight gain

Fatigue-With a reduced supply of freshly oxygenated blood to meet the body's needs, blood is diverted away from less vital organs, particularly muscles in the arms and legs, making them more susceptible to fatigue.

Reduced Appetite and Nausea-The digestive system receives less blood, thereby reducing appetite and causing digestive problems.

Difficulty Concentrating-Changes in blood components, such as an increase in sodium, can affect alertness, as can not getting enough blood to the brain.

Increased Heart Rate-To try to make up for its reduced capacity to pump blood, the heart beats faster.

Sciatica refers to leg pain caused by a herniated disk in the spine that presses on the sciatic nerve. People with sciatica often experience intense pain that radiates into the buttocks, down the thighs, and into the calves, and often into the feet.

Surgery can provide fast pain relief for sciatica, but you might do just as well without an operation, a study finds.

In this study, researchers randomly assigned 281 people with sciatica for at least six weeks to have surgery to decompress the nerve; or, to receive conservative treatments such as pain medication and exercise. On average, people who had sciatica surgery felt their leg pain was better after four weeks while it took about 12 weeks for those who did not have surgery to note improvement. But within one year, 95% of the study participants said they felt significntly better, no matter which sciatica treatment they had.

Bottom line advice: If you are experiencing searing pain or numbness in your leg from sciatica and conservative treatment is not working, then surgery may be right for you. On the other hand, if you feel you can handle the leg pain and are willing to postpone sciatica surgery, you might find that you don't need it. Always discuss options with your doctor.

In this study, researchers looked at the medical records of more that 4,000 veterans age 80 and older with high blood pressure. Participants who lowered their blood pressure to just below the upper limit of normal - 139/89 mm Hg - were less likely to die of any cause over a five year period than those who reduced their blood pressure to lower levels. This relationship held when the researchers took into account other illnesses that can lead to premature death.

These findings do not contradict current guidelines that recommend lowering blood pressure to below 140/90 mm Hg. But they do suggest that aggressive lowering of blood presure beyond this level could be harmful for people over age 80, possibly because of reduced blood flow to vital organs.

If you are 80 or older and experience any symptoms of aggressive blood-pressure lowering such as dizziness, weakness, or thinking problems tell your doctor who then may make changes to your treatment regimen.

Although no one likes to think about having a heart attack,would you know what to do if you were? Even if you know what to do, would you follow through and more importantly, would you do it quickly?

According to the National Heart, Lung, and Blood Institute close to one million people in the United States have heart attacks each year; and, about one fifth of them die. Half of the deaths occur in the first hour after heart attack symptoms start and before the person reaches a hospital. These numbers underscore the importance of recognizing heart attack symptoms quickly and responding to these symptoms just as quickly,

Now a study in the European Heart Journal (Volume 27, page 1408) reports that for women, persistent chest pain may be a waning of future heart problems - even when a woman has no evidence of blockages in her coronary arteries.

The findings come from a study known as WISE, a government-funded project designed to evaluate chest pain in women - a task that is less straightforward than in men. The central isue is that women are much more likely than men to suffer long-term chest pain in the absence of any large artery blockages. But that doesn't mean their chest pain is innocuous.

Among women in the study with no signs of clogged arteries, those with persistent chest pain for at least a year were more that twice as likely to suffer a heart attack, stroke or other cardiovascular complication over the next five years. The study included 637 women whose chest pain and other potential symptoms of coronary heart disease were evaluated by angiography (an x-ray examination of blood vessls that can detect blockages).

The take home message is if you are a woman, you should not simply live with chronic chest pain if angiography fails to detect artery blockages. Instead, you should ask your doctor about ways you can reduce any heart risk factors you have. Remember, a healthy diet and regular physical activity are two of the most important ways.

You probably know the symptoms of a heart attack, but it's just as important to know the symptoms of a stroke. Like a heart attack, a stroke is an emergency that requires immediate medical attention. Even a TIA, in which the stroke symptoms appear suddenly and quickly subside, is a medical emergency.

Whether you are having an ischemic or hemorrhagic stroke, the symptoms are the same. With a TIA,the symptoms are transitory, often lasting only minutes. If you or someone you are with experiences the sudden onset of any of the stroke symptoms listed below - even if the symptoms start to subside - you MUST call 911 or go straight to the hospital. Rapid diagnosis and treatment of a stroke may minimize damage to the brain tissue and improve the chances of survival. Stroke symptoms include:

Sudden weakness or numbness in the face, arm, or leg on one side of the body.
Sudden loss, blurring,or dimness of vision.
Mental confusion, loss of memory, or sudden loss of consciousness.
Slurred speech, loss of speech, or problems understanding others.
A sudden, severe headache with no apparent cause.
Unexplained dizziness, drowsiness, or lack of coordination.
Nausea and vomiting, especially when accompanied by any of the preceding symptoms.

The importance of responding immediately to symptoms of a stroke is underscored by a study in the journal Neurology(Volume 64, page 817). Note that the warning signs of an ischemic stroke may occur up to seven days before the event itself, according to researchers, and these signs should be taken seriously to minimize the chance of a major stroke.

There is no universal rating system to help determine if a patient has delerium; however, the reliability of the following criteria tested positively in a study published in the Journal of Geriatric Psychology. Some central characteristics that researchers identified are listed below. Examples of the type of behavior that might indicate each characteristic are also included.

Shifting attention
Unable to concentrate during conversations.
Switches topics frequently.
Easily distracted.
Completely inattentive.

Poor orientation
Has problems articulating the date.
Doesn't know the days of the week.
Doesn't know where he or she is.
Has trouble recognizing family members.

Incoherence
Speech is difficult to understand.
Stops in the middle of a sentence.
Cannot express thoughts.

Restlessness and anxiety
Jumpy, edgy, or fidgety.
Suspicious of others.
Anxious and afraid.
Requires frequent reassurance.

Delusions and hallucinations
Perception is distorted or completely wrong.
Sees shapes or objects incorrectly.
Smells scents that are not there.

Poor cognition
Cannot spell simple words backwards.
Cannot do simple math.
Cannot recognize simple patterns of words or numbers.

Research reported in the journal Chest (Volume 127, page 1658 May 2005) shows that people who are overweight, drink a lot of carbonated beverages, snore, experience daytime sleepiness or insomnia, have a high blood pressure or asthma, or use anti-anxiety medications such as diazepam (Valium) are most likely to experience the problem.

The subjects were part of the Sleep Heart Health Study, a national trial that enrolled 15,314 people to investigate the link between breathing problems during sleep and cardiovascular disease. Among the questions was "how often in the past year, on average, have you been awakened during the night with heartburn or indigestion?" The responses indicated that 1/4 or 3,806 people, in this group reported the symptom at least twice a month. People with nighttime heartburn are at greater risk for more serious esophageal problems such as erosive esophagitis, Barrett's esophagus, and esophageal cancer.

If you experience nighttime heartburn on a regular basis, or have bouts of asthma, a nagging cough or episodes of chest pain, talk with your doctor. In addition, try to control the risk factors identified in this study - for example, keep your weight and blood pressure under control and cut down on your soda intake.

Occasional memory lapses, such as forgetting why you walked into a room or having difficulty recalling a person's name, become more common as we approach our 50s and 60s. It's comforting to know that this minor forgetfulness is a normal sign of aging, not a sign of dementia.

Here are examples of the types of memory problems common in normal age-related forgetfulness, mild cognitive impairment and dementia.

Normal Age-Related Forgetfulness:

Sometimes misplaces keys, eyeglasses, or other items.
Momentarily forgets an acquaintances's name.
Occasionally has to "search" for a word.
Occasionally forgets to run an errand.
May forget an event from the distant past.
When driving, may momentarily forget where to turn. Quickly orients self.
Jokes about memory loss.

Mild Cognitive Impairment:

Frequently misplaces items.
Frequently forgets people's names and is slow to recall.
Finding the desired word becomes more difficult.
Begins to forget important events and appointments.
May forget more recent events or newly learned information.
May temporarily become lost more often.
May have trouble understanding and following a map.
Worries about memory loss. Family and friends notice the lapses.

Dementia:

Forgets what an item is used for or puts it in an inappropriate place.
May not remember having known a person.
Begins to lose language skills. May withdraw from social interaction.
Loses sense of time. Doesn't know what day it is.
Short-term memory is seriously impaired. Has difficulty learning and remembering new information.
May have little or no awareness of cognitive problems.

Now researchers may have found a connection between sleep habits and high blood pressure. In a study reported in the Journal Hypertension(Volume 47, page 833) researchers studied more than 4,800 Americans and found that young and middle-aged adults who clocked five or fewer hours of sleep each night were 60% more likely than their well-rested peers to develop hypertension over the next decade. Lack of sleep did not appear to raise blood pressure in adults older than age 59, however.

The link between sleep habits and blood pressure remained even agter the researchers controlled for weght, depression, smoking, and physical activity levels. This means there may be something about chronic sleep deprivation that raises a person's blood pressure.

One possibility us that people who get little sleep have more exposure to the elevations in heart rate, blood pressure, and nervous system activity that come with being awake. As a result, the body may adapt to these chronic elevations by operating at anew, higher level. Chronic sleep deprivation might also throw a wrench in the central "clock" in your brain, which governs the rythem of bodily processes, including blood pressure control. People vary in the amount of sleep they need, but experts recommend that adults get at least a good six hours of sleep a night.

Here's why:
Nasal congestion occurs when the blood vessles in the lining of your nose expand due to a cold or allergies. nonprescription decongestaant nasal sprays such as phenylephrine (Vicks Sinex, others) and oxymetazoline (Afrin, others) reduce that congestion by narrowing those blood vessles.

The problem is that after a few days of relief, your nasal membranes become tolerant and less responsive to the spray. The typical response is to use more spray more frequently. Not using the spray can result in rebound congestion - a period of brief relief followed by severe nasal obstruction.

To reverse tolerance to these sprays stop using them for several weeks. Instead, try using saline nasal sprays which don't cause rebound congestion. If your congestion is related to allergies, try a nonprescription antihistimine decongestant tablet or ask your doctor about prescription nasal sprays, such as azelastine (Astelin), budesonide (Rhinocort Aqua), fluticasone (Flonase),ipratropium bromide (Atrovent), mometasone (Nasonex) and triamcinolone acetonide (Nasacort AQ). These sprays are generally safe for extended use and do not cause rebound congestion.

The cause of most cataracts is unknown, but at least two factors associated with aging contribute to their development. First, clumping of proteins in the lens leads to scattering of light and a decrease in the transparency of the lens. Second, the breakdown of lens proteins leads to the accumulation of a yellow-brown pigment that clouds the lens.

Researchers have found certain chemical changes in the eyes of people with cataracts. These changes include a reduced uptake of oxygen by the lens and a rise in the water content of the lens, which is later followed by dehydration. When cataracts form, levels of calcium and sodium in the lens increase, and levels of potassium, vitamin C, and protein decrease. In addition, lenses with cataracts appear to be deficient in the antioxidant glutathione; however, studies on the use of medications or vitamins to alter the levels of these substances in the lens have not produced promising results. Currently, there is no effective drug therapy to prevent cataracts from forming. But cigarette smoking, certain drugs, eye injuries, sunlight, diabetes and even obesity can increase the risk of cataracts.

Cataracts are an opacification (cloudiness) of the eye's normally clear crystalline lens and they form painlessly. The most common symptom is cloudy or blurry vision and everything becomes dimmer, as if seen through glasses that need cleaning. Most often, both eyes are affected, though vision is usually worse in one eye than in the other. Other symptoms include glare, halos, poor night vision, a perception that colors are faded or that objects are yellowish, and the need for brighter light when reading. Symptoms can develop rapidly (in a matter of months) or almost imperceptibly over many years.

If you report sexual dysfunction, the first thing your doctor will do is a thorough medical workup to rule out such physical problems as hypertension, diabetes, urological problems and neurological problems, all of which can cause such dysfunction.

If antidepressants are the likely cause, there are several possible remedies. First, you and your doctor may consider switching to an antidepressant with a low rate of sexual side effects, such as Wellbutrin (bupropion). This would be done carefully to minimize the risk of a relapse of depression. Your doctor may also suggest adding Wellbutrin to your current antidepressant regimen. Research has shown that small doses of Wellbutrin in combination with other antidepressants can be helpful in alleviating the sexual side effects of those antidepressants. There are a number of other remedies that you and your doctor might try such as adding sildenafil which is effective for combating antidepressant-induced sexual dysfunction in both men and women. Perhaps your doctor may decrease your antidepressant dose to some slight degree or change the time you take your medication. Dividing the medication dose and taking it twice a day may also diminish side effects. Finally, your doctor may have you take a "drug holiday" for a two day period which will lower the rate of sexual side effects without increasing the risk of a recurrence of depressive symptoms.

All remedies discussed above should be implemented only with physician support and supervision to prevent relapse of depressive symptoms and drug withdrawl reactions.

A report in the Archives of Internal Medicine(9Volume 166, page 1763) suggests that taking Viagra at bedtime may worsen severe obstructive sleep apnea. This may be disturbing news to many men, because erectile dysfunction is particularily common among those with sleep apnea. Viagra prolongs the action of nitric oxide, which promotes upper airway congestion, thereby contributing to sleep apnea. The researchers studied 14 men with severe sleep apnea, who spent a night in a sleep lab having their breath and blood oxygen monitored after they took a single 50-mg dose of Viagra or a placebo.

Just one dose of Viagra significantly increased the amount of sleep time with a lower blood oxygen saturation level; while asleep, men who took Viagra were not getting as much oxygen as those wo took a placebo. They also had more breathing pauses per hour.

Bottom line advice on Viagra and sleep apnea is if you take Viagra and have sleep apnea, talk with your doctor about whether the pleasures you derive from taking the drug outweigh the risks of worsening your nighttime breathing problems.

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