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Kratom not a safe choice

Dear Dr. Roach: With the current popularity of CBD and hemp products, I wonder your thoughts on Kratom, another plant-derived product. It is sold nearby. Is it an effective way to treat anxiety? — D.H.A.

Answer: Kratom is an herb (Mitragyna speciosa) often used as treatment for opioid withdrawal, as a stimulant or sedative (depending on dose), or as a treatment for such diverse medical conditions as diarrhea and muscle pain. It is also used as a recreational drug. I have talked to several people who are enthusiastic users of this product and who feel it is safe and effective.

Unfortunately, the medical literature is much more concerning. There are thousands of reports of adverse effects from kratom, including seizures, hallucinations, coma and death. There were 44 deaths related to kratom in 2017 identified by the Food and Drug Administration. It has addictive potential and may cause withdrawal when stopped. One manufacturer was forced to recall all kratom products due to contamination with salmonella in 2018.

There is no good evidence that kratom is effective for anxiety or any other symptom, and clear evidence of potential for harm, which is why I recommend against its use.

Dear Dr. Roach: Since I can remember, I’ve always had the exact same sleep habits. I go to bed between 10 p.m. and 10:30 p.m., and wake up at 6:00 in the morning. It’s been the same all through my adult life, until about one year ago. I’m 76 and have had high blood pressure since my 30s, a family inheritance.

For the past year, I have woken up at 2 a.m., go back to sleep, wake up at 4:00. The I go back to sleep and wake up around 6:00. It’s like this seven days a week. I miss the continuous eight hours of sleep I used to get. I feel tired occasionally.

I’ve tried taking the over-the-counter sleep medications, but they appear to interact with my blood pressure meds and I feel drowsy most of the day. I’ve been on the same medications for years without any issues.

I’m active and still walk 18 holes of golf. Is there something my doctor is missing in my tests? — J.K.

Answer: There are many types of sleep problems, and yours is called fractured sleep. Fractured sleep is extremely common as people get older, and it is likely that there would be no abnormality found in any tests your doctor could run.

The fact that you have only occasional tiredness makes me suspect your sleep issue is due to the normal physiology of aging than any medical issue causing a sleep disturbance.

That being said, there are at least two medical issues that are always worth considering in a person with sleep disturbance. One is sleep apnea, an incredibly common condition where people stop breathing during the night, normally lasting a few seconds, but which can happen many hundreds of times per night, causing fatigue and sleepiness during the day, and sometimes headache, high blood pressure and other problems.

The second is depression. Symptoms of depression may be hard to recognize, and a screening set of questions is recommended for all adults, but it is particularly important for pregnant and postpartum women and the elderly. Screening questions are easily done by your physician, and if your provider doesn’t do it, you can ask for screening and appropriate follow-up.

It’s possible your doctor is missing a cause, but a thorough history and physical examination is worth more than tests, and it’s also possible there’s nothing wrong.

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 or send mail to 628 Virginia Dr., Orlando, FL 32803.