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Tue, June 25

Treating varicose veins can ease RLS

Dear Dr. Rosenberg,

I have restless legs syndrome. It keeps me from falling asleep, sometimes for hours. It also bothers me when I am in the car and my legs are not moving. Also, I have varicose veins and my legs swell. I am thinking of seeing a vascular specialist. I have been told this might give me some relief for the restless legs syndrome. What do you think?

A: Vascular treatment for varicose veins is called sclerotherapy. A chemical irritant is injected through the skin to close unwanted varicose veins. Several studies have shown improvement in symptoms of restless legs syndrome (RLS) with this procedure. In one study consisting of 113 patients with RLS and varicose veins, relief was achieved and maintained at two years in 72 percent of those treated. There are some contraindications to the procedure such as active inflammation in the vein. However if you have not been able to get relief with commonly used medications for restless legs syndrome, or have experienced unwanted side effects from these drugs, it would appear to be a reasonable alternative.

Dear Dr. Rosenberg,

I was recently diagnosed with a disease called pulmonary hypertension. I underwent extensive testing and my doctors could not find a cause for it. Now they want me to undergo a sleep study. I am not sleepy and my oxygen levels are normal during the day so what is the point?

A: The point is that many people with pulmonary hypertension have low oxygen levels while sleeping. Studies have shown this can be due to destruction of blood vessels and small airways by the disease process. However, in a recent study published in the January 2113 issue of the Journal Chest, 80 percent of the subjects with pulmonary hypertension had sleep apnea and most had no symptoms of sleepiness. The importance of finding out if you have low nighttime oxygen due to one or both of these causes is that untreated it will cause the pulmonary hypertension to progress much faster.

Dear Dr. Rosenberg,

My 9-year-old daughter is taking Singulair for asthma. She takes it at night. Since starting it she has been having trouble staying asleep. Do you think there could be a relationship?

A: Yes. Although uncommon, Singulair (Montelukast) has been associated with insomnia. It has also been associated with the development of nightmares in some people. I would recommend you bring this to your healthcare provider's attention. Something as simple as stopping it for a few days and observing whether there is an improvement in your daughter's sleep may be all that is necessary.

Dear Dr. Rosenberg,

I was switched to the night shift at my factory. I am having a hard time staying alert while on the job. I started drinking coffee all night but then I can't stay asleep the following day when I need my sleep. Would you have any ideas?

A: What you are experiencing is a very common problem in people working the night shift. However, there are some potential solutions. First, try taking a one- to two-hour nap just before going to work. Second, it's okay to drink coffee but limit it to no more than one cup at the beginning of the shift. In fact, this combined with a pre-work nap has been found to be more effective than either alone. Finally, if all else fails speak to your doctor about the medications that have recently been approved by the FDA for shift workers to help them stay alert and awake at work.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him through the form at or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Drive, Prescott Valley, AZ 86314.

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