ArcaMax

DEAR DR. ROACH: My wife was having problems getting to sleep and has stocked our medicine cabinet with various p.m. versions of popular pain relievers that have been advertised as sleep aids. Recently, I've had problems getting to sleep as well and began taking a single pill before retiring, but I can't honestly say that they're helping.

I would appreciate your opinion if these particular "sleep aids" work as advertised, and if so, can you recommend a preferred brand? Additionally, I seem to recall reading that continued use of certain pain relievers can lead to intestinal problems. Should I be concerned that a single, nightly dose of these types of pain relievers can lead to problems? -- T.F.

ANSWER: Over-the-counter medications that are labeled with "p.m." and advertised as sleep aids are combinations of pain relievers (acetaminophen (Tylenol), ibuprofen (Advil and others), naproxen (Aleve), and diphenhydramine (Benadryl and others). Although they are moderately effective as a sleep aid, I don't recommend them, particularly due to the diphenhydramine component.

Diphenhydramine is an antihistamine that has a side effect of making many (but not all) people drowsy; therefore, it is used to help people fall asleep. However, even this side effect has the potential for more side effects. I am particularly worried about the data consistently showing an increased risk for falls (especially among those who are older and take these medications). I am also worried about motor vehicle accidents when people drive the day after taking them.

Older men can get worsened prostate trouble with these, and although the evidence isn't absolutely convincing, people who regularly take older, sedating antihistamines like diphenhydramine do have an increased risk of developing dementia. (Newer, nonsedating antihistamines like Claritin, Allegra or Zyrtec are not associated with dementia.)

Anti-inflammatory drugs like ibuprofen or naproxen can cause intestine troubles, particularly bleeding. However, the risk from a single tablet at night is small. It's people who take the higher anti-inflammatory doses who are at the highest risk.

DEAR DR. ROACH: I have prostate trouble. I have been on 4 mg of tamsulosin for about 20 years. I don't like the side effects and have heard that I might get more side effects if I add Avodart.

Five years ago, I elected to have a prostate artery embolization (PAE) procedure to shrink my prostate. I was constantly getting up at night to urinate. I talked to a urologist, but their surgical procedures did not appeal to me. So, I found someone to do the PAE procedure, and it helped for a while. But now I am back to getting up multiple times a night.

I had read that PAE would solve my problem. Should I try it again or take a different route? -- F.C.P.

ANSWER: This is certainly a question for your urologist, as your particular situation is unique to you. However, most urologists would recommend another PAE in your situation.

PAE is a procedure where tiny microparticles are injected into the artery that leads to the prostate, blocking the blood vessels and causing part of the prostate tissue to shrink over a few days. It is common for the initial benefit to fade as the prostate continues to grow; 13% of men have a recurrence after two years, and 60% of men have a recurrence after five years. The process can be repeated in men who had a good initial response but who later had a recurrence.

Since you are concerned about medication side effects and don't want surgery, a repeat PAE might be best for you. You might also consider a medication like tadalafil (Cialis), which is often used to treat male erectile dysfunction and has a beneficial but modest effect on treating symptoms of an enlarged prostate.

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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 ToYourGoodHealth@med.cornell.edu.

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