Sometimes when I am dropping off to sleep I have episodes which I can only describe as like a ‘zap’ – jolting me awake. I have regular eye tests and nothing came up, but I am worried. I’m 71 and otherwise in good health.
Edith Tinsley, Lancashire.
Dr Martin Scurr replies: What you’ve described is a common phenomenon known as a hypnagogic hallucination – these are vivid, but transient hallucinations that occur in between wakefulness and full sleep (known as the hypnagogic state of sleep).
Generally, those affected experience something visual – often a moving image (patterns, for instance) or vivid images of faces or scenes, but some people hear background sounds. Others may also have a sensation such as 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 linked to narcolepsy – a condition where people fall asleep suddenly in the day.
They are not the same as nightmares, which occur when someone is fully asleep.
Transient hallucinations are very common, affecting up to 70 per cent of people at least once and are not associated with any disorder. I hope that you’ll find this explanation reassuring.
These hallucinations can be triggered by stress, lack of sleep or caffeine, writes DR SCURR
I have been diagnosed with fibroids, a thickening of the womb, and a small hernia. Consultants have told me they won’t remove the fibroids, as they are less than 5cm. I suffer constant constipation, bloating and a distended stomach; I feel like I’m carrying a football around with me. I also have constant pain, similar to period pain. I’m 69 and do not want to put up with this for the rest of my life.
Andrea Ford, Newtown, Powys.
Dr Martin Scurr replies: Uterine fibroids are non-cancerous growths occurring inside the uterus (womb) or within the womb wall.
There may be one – or several. I’ve seen them as large as a tennis ball and occasionally the size of a rugby ball. It’s not known why they develop, although it’s thought to be a combination of genetics and hormonal factors.
They form during a woman’s reproductive years – oestrogen fuels their growth – and consist of smooth muscle cells and fibrous tissue. Once oestrogen levels reduce, post menopause, fibroids stop growing and slowly reduce. They never entirely disappear, and they can also harden due to a build-up of calcium deposits.
Fibroids cause symptoms in women who are menstruating (such as heavy periods), but not in post-menopausal 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 check for anaemia and to rule out an abnormal blood count, with inflammatory markers also being checked.
I’d also expect you to be offered a faecal immunochemical test, which is a home test where you send off a stool sample to be tested for traces of blood – and for your GP to arrange a colonoscopy to inspect the lining of the bowel.
If you are taking hormone replacement therapy (although I suspect not, given your age), it is possible that the oestrogen could be stimulating the fibroids to grow. Do seek the advice of your GP on further testing.
IN MY VIEW: What’s real cause of rise in ADHD?
You can’t have missed the rise of attention deficit hyperactivity disorder (ADHD). Before 1990 I’d never heard the term, yet by the year 2000 we had guidelines on diagnosis and treatment from the National Institute for Health and Care Excellence.
Now we read regularly of celebrities diagnosed with this complex disorder in adulthood.
Untreated, a child with ADHD can experience significant educational and social difficulties and have a high chance of academic failure, as well as difficulties in finding employment in adult life.
The question I would ask, while not doubting the severity of its impact, is whether ADHD is an illness or an extreme of human behaviour, at one end of the spectrum of what is acceptable.
The right dose of the drug used to treat children with ADHD – methylphenidate (brand name, Ritalin) – enables them to behave normally almost at once. For me, the speed of the response speaks volumes about this not being a physiological problem.
And I do wonder if one day we will have a fancy form of imaging that will show a neurological lesion that is the seat of this disorder. It remains to be seen.
