Sometimes, when I’m falling asleep, I have episodes that I can only describe as a ‘zap’, startling me awake. I get regular eye exams and nothing comes up, but I’m worried. I am 71 years old and otherwise in good health.
Edith Tinsley, Lancashire.
Dr Martin Scurr responds: What you’ve described is a common phenomenon known as hypnagogic hallucination: they are vivid but transient hallucinations that occur between wakefulness and complete sleep (known as the hypnagogic dream state).
Typically, those affected experience something visual, often a moving image (patterns, for example) or vivid images of faces or scenes, but some people hear sounds in the background. Others may also have a sensation like falling.
These hallucinations can be triggered by stress, lack of sleep, caffeine, or several different medications, including antidepressants (e.g., fluoxetine, amitriptyline), possibly as a result of their effect on nerve pathways in the brain. More rarely, these episodes are related to narcolepsy, a condition in which people suddenly fall asleep during the day.
They are not the same as nightmares, which occur when someone is completely asleep.
Transient hallucinations are very common, affecting up to 70 percent of people at least once, and are not associated with any disorder. I hope you find this explanation reassuring.
These hallucinations can be triggered by stress, lack of sleep or caffeine, writes DR SCURR
I was diagnosed with fibroids, thickening of the uterus and a small hernia. The consultants have told me that they will not remove the fibroids because they are less than 5cm. I suffer from constant constipation, bloating and a distended stomach; I feel like I’m carrying a soccer ball with me. I also have constant pain, similar to period pain. I’m 69 years old and I don’t want to put up with this for the rest of my life.
Andrea Ford, Newtown, Powys.
Dr Martin Scurr responds: Uterine fibroids are noncancerous growths that occur inside the uterus (womb) or within the wall of the uterus.
There may be one… or several. I have seen them as big as a tennis ball and occasionally the size of a rugby ball. It is not known why they develop, although it is believed to be a combination of genetic and hormonal factors.
They form during a woman’s reproductive years (estrogen drives their growth) and consist of smooth muscle cells and fibrous tissue. Once estrogen levels decrease, after menopause, fibroids stop growing and slowly shrink. They never go away completely and can also harden due to the buildup of calcium deposits.
Fibroids cause symptoms in women who menstruate (such as heavy periods), but not in postmenopausal women.
So the question for you is to determine the cause of your constipation and bloating. One possibility is a form of irritable bowel syndrome: this cannot be diagnosed without eliminating other potential causes.
The first step should be blood tests to detect anemia and rule out an abnormal blood count, also controlling inflammatory markers.
You would also expect to be offered a faecal immunochemical test, which is a home test where you send a stool sample to be tested for traces of blood, and for your GP to arrange a colonoscopy to inspect the lining of the intestine.
If you are taking hormone replacement therapy (although I suspect not, given your age), it is possible that the estrogen is stimulating fibroid growth. Seek advice from your GP about further testing.
IN MY OPINION: What is the real cause of the increase in ADHD?
The rise in attention deficit hyperactivity disorder (ADHD) cannot have been missed. Before 1990 I had never heard the term, however in 2000 we had guidelines on diagnosis and treatment from the National Institute for Health and Care Excellence.
We now regularly read about celebrities who have been diagnosed with this complex disorder in adulthood.
If left untreated, a child with ADHD can experience significant educational and social difficulties and have a high probability of academic failure, as well as difficulty finding employment in adult life.
The question I would ask, without doubting the seriousness of its impact, is whether ADHD is an illness or an extreme human behavior, at one end of the spectrum of what is acceptable.
The correct dose of the drug used to treat children with ADHD – methylphenidate (brand name Ritalin) – allows them to behave normally almost immediately. To me, the speed of the response speaks volumes that this is not a physiological problem.
And I wonder if someday we will have an elegant form of imaging that shows a neurological lesion that is the site of this disorder. It remains to be seen.