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Today's Ajenda issue #3

Today's Ajenda issue #3

April 10, 2024

TODAY’S DOSE OF HONESTY

Is it bad to take a sleeping pill every night?

Have you ever taken Ambien or Xanax or any other prescription drug to help you sleep? If so, you’re not alone: Data from the CDC’s National Center for Health Statistics reveals that about 8.4% of adults—nearly 3 million of us—take sleep medications almost nightly. And the trend is most pronounced in women and older adults.

We are a country of chronically sleep-deprived people, yet we often consider sleep a luxury when it’s actually a medical necessity. And as noted above, women tend to suffer from sleep problems more than men do. Why? Being light sleepers is hard-wired into the female brain: It allows us to perform our nurturing duties at any moment. If you’ve had a baby, you know what I’m talking about. When my daughter was a toddler, I could literally SENSE her standing next to my bed! That’s how lightly I slept. Similarly, when I got paged in the middle of the night for a patient in labor, my brain had to whip from sleep to full-blown-triage-doctor-mode in seconds. But that’s not just MY brain—it’s the female brain, ready to leap into action in a heartbeat. Add on stress, changing hormone levels, stimulant foods/beverages (caffeine and alcohol are both major sleep disrupters), a snoring spouse, and a suboptimal sleep environment, and the result is not pretty. No wonder so many of us ask a healthcare provider for sleeping pills.

Here’s the problem. In the short-term, prescription sleep aids can be safe and effective. But long-term, they can cause more harm than good, and what’s sneaky is that you probably won’t realize it’s happening. Ambien (zolpidem) is not FDA-approved for long-term use (more than 3 months), and neither is Xanax or any drug from the benzodiazepine class. Taking zolpidem long-term has been associated with disturbing behavior changes, during which some people have demonstrated bizarre nighttime behaviors like preparing food and even driving while actually asleep. And studies have linked prolonged use of benzodiazepines (like Xanax) to a host of potential health risks, including addiction, cognitive impairment, dementia, accidents that cause bone fractures, and even death.

What if you simply cannot sleep without a pill? There are two approaches:

Plan days when you don’t take the medication to give yourself a break from nightly use. Even if this means the quality of your sleep will not be ideal, the benefits of skipping days when you take it may be worth it. Perhaps you decide to sacrifice your weekends, since being tired on a Saturday or Sunday morning may not have the same physical (and mental) impact as being tired during the workweek. Or maybe try taking the pill every other night instead of every night.

Revisit your sleep behaviors (aka sleep hygiene). Splurge on new PJs (or try sleeping naked!) or buy a better mattress. Make your bedroom cool, dark, and quiet; 66 degrees is actually the ideal sleeping temperature. Block all sources of light, and don’t look at a phone or screen within an hour of going to bed. If you wake up during the night to use the bathroom, do NOT look at your phone! Your brain will “wake up” and stop producing melatonin, and the rest of your night might be miserable. Set a regular bedtime and wakeup time and stick to those (or within an hour) every day; it’s a myth that you can make up lost sleep on the weekend. Daily exercise earlier in the day and meditation will both help your sleep, as will avoiding alcohol. If your spouse snores and you have the option of a different room, go for it. (And gently suggest your spouse get evaluated for sleep apnea!)

So, my dose of honesty on sleeping pill use is this: Once in a while (if you are upset or traveling and jet-lagged), taking prescription sleeping pills is fine. Every night is NOT fine, and the risks far outweigh any benefits.

SYMPTOM SOLUTIONS

5 expert tips for a more youthful neck.

It’s one area of our skin that will instantly age us, and one that many of us just forget about: our necks. Nothing looks more mismatched than a face with great skin and a neck that looks neglected. And it DOES seem that our necks age faster than our faces.

Here’s the scoop: According to my Core Expert, dermatologist Dr. Michelle Henry, the skin on our necks is thinner and more delicate than facial skin, making it more susceptible to damage from sun exposure, smoking, poor diet, and excessive alcohol consumption. Poor posture over time can also contribute to saggy neck skin. These factors along with the body’s natural loss of collagen as we age typically result in earlier signs of aging on the neck than the face. But there are steps you can take to fight back. Here is Dr. Henry’s at-home regimen for a more youthful neck:

Always apply broad-spectrum SPF 30+ sunscreen daily to the neck area to prevent sun damage, which can accelerate aging and cause discoloration, laxity (sagging), and wrinkles.

Add retinol to your routine. Retinol stimulates collagen production and reduces the appearance of fine lines and wrinkles on the face and neck. Start slowly, as the neck can be quite sensitive.

Smooth on antioxidant “insurance.” Antioxidants such as vitamins C and E and ferulic acid help protect your skin from any damage your sunscreen may have missed.

Exfoliate regularly, as you would your face. Exfoliants remove hyperpigmentation and stimulate collagen, helping to reduce the appearance of age spots and encourage a more even skin tone.

Hydrate! Moisture is vital! Products with hyaluronic acid, glycerin, and ceramides are great for maintaining skin elasticity and smoothness. Drinking enough water (at least 8 glasses daily) will help hydrate your skin as well.

Our Core Expert

Michelle Henry, M.D., F.A.A.C., is a board-certified dermatologist and Harvard-trained Mohs surgeon who treats patients at her Skin & Aesthetic Surgery of Manhattan practice in New York City. She is clinical instructor of dermatology at Weill Cornell Medicine in NYC. @drmichellehenry

COMMUNITY

“Do eggs belong in a healthy diet?
Are they safe to eat?”

Eggs. One day they’re good for you, and the next, not so much. I want to talk about two timely headlines regarding eggs, and hopefully dial down any fear about eating them.

First, the cholesterol conundrum. Our lousy cholesterol, our LDL, is dictated partially by the foods we eat and partially by age, genetics, and other factors. We know, conclusively, that people with elevated or high LDL cholesterol are at greater risk of heart attack, stroke, and certain types of dementia. We also know that eating a diet low in saturated fats (like animal protein or fried food) is associated with reduced risk of these adverse events, as well as decreased levels of LDL in our blood. But that’s not the entire cholesterol picture.

We actually NEED cholesterol in our diets to manufacture hormones in our bodies and maintain strong cell walls. Additionally, if a person follows a very strict diet (e.g., a plant-exclusive or very low-fat eating plan) to lower their LDL, they can expect that number to drop by just about 20%. This is progress, but it might not be enough to get their LDL number into a safe and healthy range. That doesn’t mean you shouldn’t do it—it means that our behaviors are just one part of the equation.

Now to the egg itself. As a nutritionist, I consider eggs to be a true superfood. One large egg is just 78 calories and provides 6-7 g of protein, 5 g of fat (which is low), less than 1 g of carbs, and nice hits of essential minerals, vitamins A and D, and a wealth of B vitamins. In fact, eating two eggs per day covers up to 30% of the vitamin requirement for human nutrition. If you can get organic eggs, I tend to think they are better, but there is no good data to support this.

An egg also contains 187 mg of cholesterol. But consider this: A recent study found that, over a 4-month follow-up period, there was no increase in LDL levels of people who ate 12 eggs a week. The 4-month time period would be sufficient to show change, if there was any.

Here’s the bottom line: It really isn’t about one specific food being “bad or good” for you. More likely, it’s a combination of foods and numerous other genetic and lifestyle factors that move your health needle in one direction or the other. If you like the taste of egg whites, go for it, though you’ll miss some of the vitamin D and good cholesterol found in the yolk.

Finally, while we’re on the subject of eggs: You can’t think of eggs without thinking of chickens—birds. Recently, the U.S. marked what is thought to be the first documented case of avian influenza (aka bird flu) transmitted from a cow (a mammal) to a human. The case was not clinically serious, but it did remind us that we’re seeing high rates of avian flu in poultry (chickens, turkeys, ducks, etc.) in this country. Tens of millions of birds have been culled in an effort to stop the spread of this virus. According to the CDC, though, there is very low risk from eating properly cooked eggs or poultry at this time. For more information on egg safety, click here.

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ABOUT DR. JEN

In her roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—“Dr. Jen”—shares the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has written several books, including the best-selling The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…