DEAR DR. DONOHUE: I am on Lunesta, a prescription sleeping pill for insomnia. The nurse practitioner wanted me to take half a pill every third night, but that didn’t work for me. I have to take half a pill every night. Now she wants me to take half a pill every other night because she’s afraid that it will become habit-forming. What do you think of this medicine? – S.S.

ANSWER: All sleeping pills should be taken for as short a time as possible. “As short a time as possible” implies that the person recovers from whatever it is that’s preventing him or her from falling asleep. In the real world, a correctible cause for insomnia often isn’t found, and then a person is faced with having to stay on a sleeping pill or stay awake for most of the night. I would choose option one, as long as the sleeping pill isn’t causing any trouble, like daytime sleepiness. From time to time, it’s in your interest to try and stop the pill. You might find that sleep isn’t as elusive as it was when you started taking it.

Lunesta is one of the newer sleeping pills, tolerated well by most. It starts to work in 10 minutes, so it’s useful for those who find falling asleep difficult, and it has extended action to prevent waking in the very-early-morning hours.

Lunesta has caused some users to behave differently. A normally reserved person might become quite aggressive. It also has caused a very few to do things they have no recollection of doing. A very small number of people have driven a car under the influence of Lunesta and have not realized that they did it. If a person has such experiences, then immediately stopping the pill is common sense.

Have you tried nondrug approaches to falling asleep? Go to bed and wake up at approximately the same time every day. Relax before bedtime. If you don’t fall asleep within 20 minutes of lying down, get up and read or listen to music. Keep daytime naps to 20 minutes or less. Don’t use caffeine within six hours of bedtime.

You can become dependent on Lunesta, as you can on most sleeping pills. Dependence means it’s hard to stop the medicine. Gradually tapering the dose can usually allow people to break any dependence. I believe that sleeplessness is worse than the prospect of dependence.

Fibromyalgia is a common cause of insomnia. The booklet on this ailment explains it and its treatment. To order a copy, write: Dr. Donohue, No. 305, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am worried about my 20-year-old daughter, who is pregnant and has about 10 more weeks to go. Her doctor found protein in her urine, and her white blood count is high. I know that a high white blood count means there is some infection in the body. What about the protein in the urine? – R.V.

ANSWER: A high white count can mean many things. If there is an infection, there will be other signs of infection also present, like fever or fatigue. In the last month or so of pregnancy, the white count is often high, and that’s normal.

The amount of protein in the urine determines the seriousness of that finding. If she spills lots of protein into the urine or if her blood pressure is elevated along with the urine protein, the doctor will take immediate steps to correct both with either medicine or rest.

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