DEAR DR. ROACH: My wife is plagued by terrible nightmares. She is 69 years old. Each night, she has horrible dreams that make her moan out loud. I wake her, but she goes back to the same type of dreams. She has done this for years. It really affects the quality of her sleep, and mine. She is exhausted during the daytime. Her father and aunt had the same symptom. — C.F.

ANSWER: The only times in my career that I have heard this complaint have been in the following situations: patients experiencing side effects from medications, those with sleep disorders and those suffering from psychological issues. Medications, especially those prescribed for depression and high blood pressure, can cause this side effect. If she takes any medication, read the literature on it to see if it might be causing her nightmares.

Sleep disorders — obstructive sleep apnea particularly, but also restless leg syndrome — can be associated with sleep disturbances.

Finally, anxiety disorders, such as post-traumatic stress disorder (PTSD), may frequently include nightmares.

However, the family history suggests a distinct disorder, nightmare disorder, which tends to run in families. In nightmare disorder, there are no other known causes. Exercise, such as yoga, is recommended for this. The most effective treatment, as far as I am able to tell, seems to be a form of cognitive behavioral therapy. Psychologists or other mental health professionals would be most likely to do this, but you need to find someone in your area with this expertise.

READERS: The booklet on asthma and its control explains this illness in detail. Readers can obtain a copy by writing: Dr. Roach — No. 602, 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. ROACH: My elbow is currently out of alignment due to overexerting it while cleaning. My personal care physician suggested therapy to correct the problem. To date, I’ve had five sessions with the physical therapist, and the forearm area is still not better. Do you believe that continued sessions would help my forearm to become better aligned? I don’t want to continue to pay for sessions that won’t resolve the problem. — S.B.

ANSWER: I think what you mean by “out of alignment” is dislocated. If that is the case, the elbow needs to be put back into place. Sometimes, the elbow gets itself back into place, but more often an orthopedic surgeon manipulates the elbow into the proper position. Whether it goes back by itself or is placed there by a doctor, physical therapy often is needed to strengthen the muscles and help the joint regain its range of motion.

I am confused, in your situation, whether the elbow is currently out of alignment — i.e., dislocated — or whether it is in the right place. If it’s still out of alignment (and both your primary-care doctor and your physical therapist should be able to answer that), then I would seek help from an orthopedic surgeon. If it’s in the right place, then five sessions may not be enough to return it to normal, although it should be improving. Please let me know what happens.

DR. ROACH NOTES: Back in January, I published a column about a gentleman with hair loss on the front and outside of his legs. I suggested a few uncommon medical diagnoses, but several readers with a good deal of common sense suggested another possibility: The fabric of his trousers might be simply rubbing off the hair. A trial of looser-fitting pants, or shorts if one is lucky enough to be able to do so, might answer the question and solve the problem. I appreciate the readers who take the time to share their own experiences and suggestions, either to my email address or by U.S. mail.

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 request an order form of available health newsletters or mail questions to P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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