dBabusca r.: I am an 81 year old man in fairly good health. When I had trouble falling asleep, I took a sip of Zzzquil, which worked perfectly every time. However, my cardiologist has since told me to stop taking such products, so I’ve turned to 5mg melatonin tablets in the evening to help induce sleepiness. Sometimes it worked and sometimes it didn’t.

One night, after drinking three beers, I also took two Gas-X gel capsules to alleviate the bloated feeling right before bed. It was about an hour after the melatonin and I quickly dozed off to sleep. Since then, I have noticed that if I wake up at night and take another Gas-X, I soon fall asleep again and have remarkable, complex dreams. Is this self-protocol of mine medically unsound in any way? — WG

Response: There’s a lot going on here. First, I completely agree with your cardiologist that the sleeping pill you are taking, like most over-the-counter sleeping pills, contains diphenhydramine, an antihistamine that sedates some people. The problem with this drug is that the quality of sleep is not good for many people. It also increases the risk of falls in the elderly and the risk of car accidents in people who drive. Not a good choice for older adults.

Melatonin is safer and has fewer side effects. One of them is vivid dreams. Five milligrams is a large dose. (I usually recommend 0.5 to 1 mg in my older patients.) Gas-X (simethicone) is not absorbed into the body and should not cause vivid dreams. A search found no reports of abnormal dreams with simethicone, so melatonin was almost certainly the cause of the dreams. Maybe the Gas-X allowed you to sleep while there was still enough melatonin to give you vivid dreams.

Additionally, three beers on a regular basis is more than what is considered healthy for anyone, and an 80-year-old man will be affected by three beers much more than a younger man of the same size.

Dr. Roach: Seven years ago, I went to the emergency room and was told I had blood clots in my arms that had traveled to my lungs. I started Eliquis. The doctor said I have a problem with factor V, but I don’t have the blood results. Do I need to stay on this blood thinner? I know it has severe side effects. — MT

Response: Factor V is a protein essential in the formation of clots, and an abnormality of this protein can cause a person to bleed (although this is very rare).

What is more common is a condition called factor V Leiden (FVL), which makes the body resistant to activated protein C, a natural anticoagulant. (Anticoagulants decrease blood clotting and are sometimes referred to as “blood thinners”). So the net effect of FVL is that it makes blood clots a little more likely. Many people have FVL, but most will not develop a blood clot.

However, it appears that you have developed blood clots in both arms that have caused the clots to move to the lungs, called pulmonary emboli. Determining the duration of therapy requires clinical judgment. Because you had clots in your arms rather than your legs, had a pulmonary embolism, and have FVL, some experts would treat you for the rest of your life.

I wouldn’t say that Eliquis has severe side effects. As it reduces blood clotting, there is a chance of bleeding. For most people with a low to medium risk of bleeding, the probability is on the order of 1% to 2% per year. If the risk of a life-threatening clot is greater than the risk of bleeding, then continuous anticoagulation is preferred.