Dear doctor

Disturbed to be awake

Q: I am 31 and have been having sleepless nights for the past few years. Sometimes I go four to five days without any sleep at night and this makes me so tired. The only way I can get a decent night's sleep is to follow a fixed pattern (be in bed by 10pm every night), which I find hard to stick to. Even when I do that it only lasts for three or four days and then it's back to sleepless nights.

A: Disturbed sleep patterns generate huge anxiety - in fact the fear of not sleeping is often worse than the lack of sleep itself. The first step is to define the problem. If you can't get off to sleep, perhaps you're not physically tired enough and need more exercise. Or you may be working until late at night and not be relaxed enough to fall asleep. If you fall asleep as soon as your head hits the pillow, but then wake a few hours later, you may have been catnapping during the day and just not need much sleep at night. Or something may be waking you - your partner's snoring or aches and pains that need treating.

Disturbed or unrefreshing sleep may, ironically, be the result of sleeping pills. If you are waking up earlier than you wish, say around 4-5am, it may be a simple matter of needing blackout lining for your curtains. But it can be a sign of depression, and if it is associated with feeling tearful, low and negative, then dealing with the depression would be more useful for you than dosing yourself on sleeping pills or lying awake fretting that you're not asleep. As you say, a strict wind-down bedtime routine - so called "sleep hygiene" - is often the only, if boring, answer. No work or caffeine after 8pm, a hot bath, a relaxing book and a set bedtime each night. Excitement or insomnia? Your choice.

My TB fear

Q: A colleague of mine has apparently been diagnosed as having TB. We have shared an open-plan office, although I didn't work particularly closely with him. I am, however, very concerned that I may have been exposed to TB as I have a young family and my wife has recently had a baby. I had my BCG vaccination as a child. We are all well and I don't have any symptoms but I don't want to put my family at risk. What should I do?

A: The answer depends on a few factors but is basically reassuring. Your risk of contracting TB is probably very small. You worked with him but did not share his home or come into very close physical contact by the sounds of it. You are well and should have a normal immune system which makes you less susceptible to infection than someone with lowered immunity. The fact that you don't have symptoms (fever, weight loss, sweats, cough and coughing up blood) indicates that you are unlikely to have the disease, in which case your family can't catch it from you. Your BCG vaccination also confers some protection. It would be useful to know just how infectious your colleague's TB is. If you can find out his full name, date of birth and the hospital he is attending, your GP can contact the public health specialists for that area and find out for you. If his TB is not a particularly infectious type, you may well be advised not to worry. If he has a particularly virulent type of infection and if there have been any other cases as a result of contact with him, you will be advised to have a screening test. This will usually be a chest X-ray, but may also include a skin test.

Feeling oddly sexy

Q: I am in my mid-50s and just over a year ago I had a total hysterectomy - womb, ovaries, cervix, the lot! I take a high daily dose of oestrogen to control osteoporosis. What puzzles me is that, without progesterone or ovaries, I still seem to have a monthly cycle of sorts, with considerably increased libido around the changeover from one set of pills to the next. This is superfluous to requirements, since I have not been sexually active since my husband died years ago. Why does it happen?

A: You do still produce some oestrogen in the fat below your skin and from adrenal glands just above your kidneys. The production is usually more constant, and less cyclical than when the ovaries are running the show, and the pills you are taking are giving you a fixed daily dose so it's hard to explain your fluctuations.

Your libido might often be heightened, though you only tune into it at the end of a packet of pills. Perhaps in time you will find a satisfying way of expressing yourself sexually again.

• 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 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.

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