DEAR DRS. DONOHUE AND ROACH: Every day, I depend on a pill to keep my blood pressure down and one to keep my cholesterol down. So what’s wrong with my depending on a pill every night to get a good night’s sleep (triazolam)? I am a male, 87 years old. — L.D.

ANSWER: It sounds like someone, maybe your doctor, is trying to get you to cut down on your sleeping pill. How come? All medicines have the possibility of side effects. The challenge as a doctor is to balance the benefit and the harm.

Both blood pressure and cholesterol medicines reduce your risk of heart disease and stroke, and the side effects are weighed against that. With sleeping medications, the risks are higher than they are for most blood pressure and cholesterol medicines. The big risk is falling: The risk of a fall is substantially higher for people who take sleeping pills than for those who don’t.

So, in the case of blood pressure and cholesterol medicines, they make you live longer (we hope) but can make you feel worse (but with any luck, not much worse). Sleeping pills, on the other hand, make you feel better but have a higher risk of falls and even of death (but very small). That’s why your doctor may be trying to get you to cut down.

Good bedtime habits — including taking in no caffeine in the evening and avoiding bright lights, the television and your computer at least an hour before bed — can help people sleep, sometimes better than sleeping pills.

DEAR DRS. DONOHUE AND ROACH: I have herpes HSV-2 (genital herpes). I learned this in 1984, when I was 39. I’ve been fortunate to get only one or two outbreaks per year. Now, I’m in my late 60s and wonder if I should or should not get a shingles shot. Could you help me make a decision? — G.F.

ANSWER: That’s an easy one. You should get the shingles shot.

Herpes simplex virus, both type I (usually in the mouth) and type II (usually genital), are related to the virus that causes shingles, Varicella-Zoster, another virus in the herpes family. But having HSV doesn’t protect you from getting shingles, and the shingles vaccine doesn’t affect the frequency of HSV outbreaks.

Shingles is common and can be very painful and even debilitating, especially in the elderly, and the vaccine reduces your chances of getting shingles, but even if you do get it, the vaccine reduces the duration and intensity of pain. You can get the shingles vaccine at many pharmacies; most doctors don’t keep it in their offices, since it has to be stored under special conditions.

DEAR DRS. DONOHUE AND ROACH: I am a 78-year-old who had a triple heart bypass 12 years ago and an angioplasty six years ago. For all those years, I took Plavix, and two years ago, my doctor put me on regular aspirin. In January, I developed some stomach problems, and a CT scan showed blood clots in my lungs. Now I have to take warfarin (Coumadin). I thought aspirin and Plavix are supposed to thin your blood, so how is it possible to develop blood clots? I also take Nexium. — H.S.

ANSWER: Blood’s ability to clot is essential to our survival, and our system to do so is very powerful and finely adapted. However, overzealous blood clotting can be a problem. Blood clots are the immediate cause of heart attacks for most people, and the major reason for strokes. Both aspirin and Plavix work on one blood-clotting system: the platelets (a blood cell that stops bleeding rapidly); meanwhile, warfarin acts on the other system: the blood-clotting factors (proteins in your blood that make a mature, firm clot).

With too little medicine, you clot; too much, you bleed. In people at higher risk for clotting, it can be impossible for even the best doctors to get the balance just right.

However, you should not mix Nexium and Plavix, since the Nexium keeps the Plavix from working. If you’re prescribed both, talk to your doctor right away about changing medicines.

The booklet on heart attacks, America’s No. 1 killer, explains what happens, how they are treated and how they are avoided. Readers can order a copy by writing: Dr. Donohue — No. 102, 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.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.

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