DEAR DR. DONOHUE: Help! For more than two years I have been troubled with severe nightmares that waken me and cause my heart to beat funny. I have been to the emergency room many times, fearing a heart attack. I have asked different doctors, ER doctors and pharmacists, but get no answer. I have enclosed a list of my meds to see if one of them might be the cause. I am worn out and cannot sleep. — M.V.

ANSWER: Just about everyone has had one or two nightmares. Few suffer from them the way you do. Frequent, terrifying nightmares that disrupt sleep and disrupt daytime alertness require the attention of a specialist.

I checked your medicine list. Propafenone (Rythmol) lists nightmares as a possible side effect. Don’t even think about stopping it unless you first talk to the prescribing doctor. It is used to control serious heartbeat disorders.

Alcohol and some Parkinson’s disease medicines give rise to nightmares. So can beta blockers, medicines used for control of blood pressure and some heart-rhythm problems. A few antidepressants also are listed as a possible cause of such dreams.

Anxiety or stress, buried so deeply in your mind that you cannot call them into consciousness, are likely causes. A psychiatrist can help you dig up these submerged thoughts that produce nightmares. A consultation will give you and the doctor an idea whether treatment will be productive. Your family doctor can make the referral.

A technique that has helped some overcome recurring nightmares is imagery rehearsal therapy. A person plagued by terrifying dreams recalls them in detail the following day and rewrites them, giving them a different and upbeat ending and peopling them with different characters. Then the person repeats the new dream version several times during the day. I don’t know how well this works. It’s simple. It’s inexpensive. It’s worth a try.

DEAR DR. DONOHUE: I have noticed that some elderly people place much importance on coffee consumption. Two women of this sort have reached the age of 80 but seem to need coffee to bolster their alertness. I doubt this has harmful effects, but please comment.

If all of us live long enough, will we all have persistent mental fatigue? — J.M.

ANSWER: You don’t have to limit your observation to elderly people. Plenty of young people don’t function well mentally until they have had a morning cup of coffee. It’s not a health danger to young or old. One to three cups a day is quite safe. Caffeine improves concentration and eliminates fatigue.

Caffeine has many other pluses. It’s said to reduce the risk of developing type 2 diabetes, gallstones, Parkinson’s disease, leg blood clots and strokes. I can’t vouch for all of these. It would be nice if only one is true.

The answer to your second question is no.

DEAR DR. DONOHUE: All my adult life, I thought to stay alive all you have to do is keep breathing. Now I’m told there’s a proper way to breathe. That way is to cause an expansion of your stomach when you inhale, not your chest. I disagree with my brother-in-law, the source of this information. Do I mow his lawn, or does he mow mine? — P.

ANSWER: Nature has provided us with mechanisms that keep us breathing without having to think about it. I’ll bet you’re breathing as your brother-in-law indicated without knowing it. Put your hand on your abdomen. Breathe normally. You’ll feel your abdomen juts out with each breath in. The reason why is that your diaphragm muscle descends when you inhale. That pushes the abdomen out and creates negative pressure in your chest. Negative pressure causes air to flow into the lungs. It’s the way nature designed us. You don’t have to be conscious of it. It just happens.

Neither of you has to mow the other’s lawn. Both are right.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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