A reader experiencing ten years of violent nightmares has sought medical advice, with Dr. Martin Scurr identifying two potential causes: REM sleep disorder or medication side effects. REM sleep disorder, a type of parasomnia, involves acting out vivid dreams, often violently, during sleep. Individuals with this condition can move and may injure themselves or their bed partners, despite the normal paralysis associated with REM sleep. This disorder is more common in men over 50 and requires diagnosis at a sleep disorder clinic, potentially involving polysomnography to monitor sleep activity.
Alternatively, if the nightmares involve recalling disturbing dreams without physically acting them out, they might be a side effect of certain medications. The beta-blocker bisoprolol, used for high blood pressure, is known to be associated with unpleasant dreams. The reader was advised to consult their GP or cardiologist if they suspect bisoprolol is the cause, rather than stopping the medication abruptly. The article notes that such conditions are often seen in men over 50 and require a referral to a sleep disorder clinic for diagnosis, which may involve polysomnography.
Blood Clot Concerns
Another reader, diagnosed with blood clots in the lungs and prescribed the blood thinner apixaban for three months, inquired about the necessity of further checks to confirm the clots have dissolved. Dr. Scurr concluded that the reader likely experienced a pulmonary embolism, often originating from a deep vein thrombosis (DVT) in the leg. While apixaban is the correct treatment, the absence of investigation into the embolism's origin, such as checking for signs of DVT in the legs, was noted as unusual. The three-month course of apixaban, if completed without further issues, suggests the existing clots likely resolved naturally. However, Dr. Scurr emphasized the importance of identifying the cause of the initial DVT, asking about immobility, long-distance travel, hormone replacement therapy, or unexplained weight loss, changes in bowel habits, unusual urinary symptoms, or night sweats. Blood tests, organ function checks, and leg ultrasounds were suggested if no clear risk factors were identified. The reader was encouraged to discuss these concerns with their GP.
Prostate Cancer Screening Debate
In a separate commentary, a doctor expressed reservations about a proposed national prostate cancer screening program based on the PSA (prostate specific antigen) blood test. The doctor argued that the PSA test yields too many false positive and false negative results. Instead, the Stockholm3 test is favored, which incorporates six factors including age, family history, protein markers, and genetics. This multi-faceted approach provides a more nuanced percentage risk score for significant prostate cancer. The benefit of this test, according to the commentary, is its ability to identify individuals with a low PSA but a high Stockholm3 risk who might otherwise be missed, prompting an urgent scan. Conversely, it helps patients with an elevated PSA but a low risk to avoid potentially harmful biopsies. While currently expensive at around £300, the hope is that wider adoption will lead to economies of scale, making it the standard screening method.