Afternoon nap is a must
I am 18 and am about to go to university to study medicine and I am concerned about the amount I am sleeping throughout the day. For about a year I have been sleeping in the afternoons for anything up to an hour. I have a regular sleeping pattern and normally have about eight hours' rest a day, but I am concerned that if I don't break this habit I could have problems concentrating in late afternoon lectures or exams. Is my sleeping pattern healthy?
As everyone in Mediterranean countries knows, an afternoon siesta is a marvellous thing. Our bodies are programmed to sleep at night and stay awake all day but an energy dip in the early afternoon is very common. Unfortunately, you may find your medical school unable to accommodate a post- lunch nap. Tips to enhance afternoon alertness include eating a hearty breakfast but smaller lunch. Avoid too much refined carbohydrate at lunchtime because that floods your body with sugar which cases an insulin surge which in turn lowers your blood sugar levels within a couple of hours. Exercise every day, avoid caffeinated drinks after 6pm and try to limit the alcohol intake so you get a good night's sleep. Speak to your tutor or student health doctor if you're feeling excessively tired. You'll manage without your afternoon nap as we all do, but that doesn't mean you won't miss it!
An infernal itch
I am 88 and in good health. However, I am plagued by an infernal itching around my vulva and back passage which is keeping me awake at night and making me very uncomfortable when I sit for long periods in the day. My GP said it was probably age-related dryness and gave me some oestrogen cream which didn't help. Any advice?
Water and chemicals may be exacerbating the itch so wash infrequently and avoid using all toiletries and creams on the itchy area. Cut your fingernails short so you can't scratch yourself raw. An antihistamine such as Piriton which is available without prescription can be taken at night to lessen the itch. Your GP needs to examine you properly and refer you to a gynaecologist if necessary to make sure there is no underlying skin problem of the vulva. A fairly common condition called lichen sclerosis causes white scarred areas on the vulva and usually improves with a strong steroid ointment such as Dermovate. Vulval itching may be part of a more widespread skin condition such as eczema or psoriasis. If you are itchy all over with no apparent skin problem, you may have an underlying problem such as diabetes or anaemia which can be diagnosed by a simple blood test.
Tormented by tinnitus
I have suffered from intermittent ringing in the ears (tinnitus) for many years and have spent thousands of pounds in search of a cure. Is there any solid evidence for specific treatments that work before I waste any more money?
The sad fact is that there is very little good evidence of effective treatments for this debilitating condition. The best evidence supports the use of betahistine during attacks of Meniere's disease which causes tinnitus, dizziness and lack of balance though it doesn't help the gradual hearing loss that may occur with successive attacks. There is some evidence to support antidepressants such as amitriptyline and a valium-type drug called alprazolam but both may cause side effects. A technique which uses electrical stimulation over the ear may be worth a try but there's no real evidence for acupuncture, biofeedback, hypnosis and Ginko. A lot of work needs to be carried out in this under-funded field.
These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email firstname.lastname@example.org or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.