Dear Dr. Roach: I wonder if you can help me. Two weeks ago, I suddenly was unable to sleep. After I got into bed, a warm feeling flowed over my chest and arms, and my heart seemed to speed up. I had a nervous feeling in the pit of my stomach 鈥� a feeling of anxiety or agitation. I lay with my eyes closed for most of the night, and sleep refused to come. My doctor gave me a prescription for alprazolam 0.5 mg as needed. I don鈥檛 want to depend on drugs. I鈥檝e never had problems sleeping previously. It seems I suffer anxiety at bedtime.
S.B.
You may be right that you are suffering anxiety. Some of these symptoms are typical for an anxiety or panic attack. Alprazolam is a good treatment for the short term, but in my opinion, it has too many negative effects for long-term treatment.
More importantly, I鈥檓 not completely convinced that this is anxiety.
The description of a warm feeling through the body and a fast heart rate always makes me nervous for a pheochromocytoma 鈥� a rare tumour of the adrenal gland that is seldom found but won鈥檛 ever be found if it鈥檚 not considered.
High thyroid hormone levels also may cause similar symptoms.
If a medical evaluation shows no evidence of these issues, then a different class of medication can be effective treatment. Or, in your case, since you want to avoid medication, counselling or cognitive behavioural therapy can be very effective.
Dear Dr. Roach: What is the difference between PAT and PSVT?
D.S.
鈥淧aroxysmal atrial tachycardia鈥� is an intermittent fast heartbeat, the source of which is in one of the atria, the top chambers of the heart. 鈥淧aroxysmal supraventricular tachycardia鈥� means almost the same thing: an intermittent fast heartbeat, the source of which is above the ventricles (which clearly includes the atria, so all PATs also are PSVTs). Apart from PAT, PSVT can be caused by abnormalities within the conduction system itself. The terms are sometimes used synonymously, even though they are slightly different.
Both PAT and PSVT have a similar appearance on an electrocardiogram, and are usually distinct from the much more worrisome ventricular tachycardia, which is a medical emergency.
Dr. Roach Writes: Several female readers wrote to me complaining about the lack of effective treatment for low libido, contrasting it with the availability of medications like sildenafil (Viagra) for men. However, these medications affect blood flow, not libido. This is commonly misunderstood. The medications are effective for men who have desire for sex but are unable to get an adequate erection. While testosterone treatment can sometimes be of benefit for low libido in both men and women, it often is ineffective, as is flibanserin, the new medication I mentioned in my previous column.
I would be happy to review any new medication treatment to help with low libido, as it is a significant problem affecting the quality of life of both men and women, and their partners, but I can't currently recommend any medication wholeheartedly, which leaves non-drug treatments, including counselling, regular exercise and sexual therapy, available for both men and women.聽
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
