Q: Can you comment on a report that chronic Ambien users are three times more likely to die of a heart attack?
A: That's not exactly what the online-only British Medical Journal study reported. What they reported is that when researchers compared the medical records of 10,529 folks who received Ambien, Restoril, Lunesta, a sedating antihistamine like Benadryl or some other sedative like Xanax for sleep with 23,676 folks who did not receive any sleeping pill over an average period of 2.5 years, there were 638 deaths in the folks who used a sleeping pill compared with 295 deaths among those that did not.
On the surface, the findings of this retrospective medical records review are downright scary. But there are a number of methodological flaws in this study. First of all, the reported cause of death was not identified. It's difficult to link the entire category of sedatives with an increased risk of death when the precise cause is not identified. Second, the folks who were taking sleeping pills had a significantly higher incidence of prior disease, including coronary artery disease, chronic kidney disease, asthma and obesity than those that were not. It appears that this study speaks more about the health of folks who require sleeping pills than the inherent dangers of taking sleeping pills. Correlation and association does not necessarily equal cause.
While the study does give us a reason to reexamine the practice of chronic use of sleep medication (especially in folks with serious underlying health problems), this study has enough flaws to let us sleep a bit easier at night.
Q: My husband suffered a stroke several months ago affecting his right side. His recovery has been slow, with only slight improvement in the use of his right arm and leg. What surprised me is that his neurologist said his stroke occurred on the left side of the brain. Can you explain?
A: One side of the brain controls the muscles of the opposite arm and leg. Study of the central nervous system has shown us that the motor nerve fibers that make arm and leg muscles move originate in the brain and cross to the opposite side of the body and run down the spinal cord, exiting as nerve roots. Why our bodies are designed this way is part of the mystery of human creation.
Left brain strokes affect the right side of the body (and left side of the face). Speech and language problems like difficulty forming or saying the correct words may also be a result of a left brain stroke.
Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H," P.O. Box 767787, Atlanta, GA 30076. Due to the large volume of mail received, personal replies are not possible. —J.H., Roswell, Ga. —P.S., McKeesport, Pa.