Mens Health Blog. Medical Blog

Valium by Hoffman La Roche was the forerunner of a large family of sedatives called the Benzodiazepines. On the face of it, the Benzodiazepines were an advance on the barbiturates, the group of drugs that they superseded because barbiturates caused respiratory and circulatory failure in overdose. A person attempting suicide with an overdose of Valium merely goes to sleep for a very long time. They wake up in an intensive care ward or the medical section of a large general hospital.

For many years the Benzodiazepines were hailed as the be all and end all in the management of anxiety and anxiety related sleep disorders. Now however the “Benzos” have fallen into disrepute. One third of persons taking Benzodiazepines become physically addicted. As time passes the same therapeutic effect requires more and more of the drug. When the drug stops withdrawal symptoms occur. Many confuse the symptoms of withdrawal with the symptoms of their anxiety disorder. They become caught in a viscous circle of ongoing habituation and inevitable withdrawal.

Benzodiazepines are best used occasionally or for short periods of time. The elderly should not use Benzodiazepines at all. They cause confusion and clumsiness. Recent reports indicate that some Benzodiazepines cause a reduction in the effectiveness of short term memory by up to 50 per cent.

The following are all Benzodiazepines: Aldorm, Antenex, Ativan, Dalmane, Diazemuls, Ducene, Emoten, Euhypnos, Frizium, Halcion, Hypnodorm, Hypnovel, Lexotan, Librium, Mogadon, Murelax, Normison, Rohypnol, Serepax, Temaze, Tranxene, Valium and Xanax.

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Case 1

A 32 year old woman enjoyed good health and led a particularly busy life with three young children and a part time job. She and her husband heard a discussion about snoring and OSA on a late night variety show on television which they viewed with mild amusement until some of the more serious aspects of the syndrome were aired. The wife was in fact a snorer but it rarely disturbed her husband as he was a very sound sleeper. Some months later she had reason to see her doctor on an unrelated matter and although rather embarrassed, she brought up the subject of her snoring. On examination she was found to have excessive fleshy tissue associated with the soft palate at the back of her throat, narrowing the entrance to the upper airway. There was no history of daytime breathing difficulty and no evidence of underlying disease. Referral to a sleep disorders unit confirmed her husband’s account of nocturnal snoring but there were no episodes of complete airway obstruction and none of the measurable features of OSA. Surgery to remove tissue from the throat was an option but as neither the patient nor her husband was particularly disturbed by the snoring, they chose not to intervene.

Comment: This woman’s state of health and level of physical activity makes the diagnosis of OSA extremely unlikely. The exclusion of underlying sleep disorders is reassuring for both doctor and patient and should never be considered a waste of time.

Case 2

A grossly obese 41 year old male was admitted to hospital for knee surgery. He lived alone in a small unit, was unemployed, had no interest in outdoor activities or hobbies and had very poor dietary habits. At 180 Kg, with high blood pressure and a failing heart he was not a good candidate for anesthesia. It was decided to seek the opinion of a respiratory specialist when nursing staff and fellow inpatients complained of his loud and unrestrained snoring and it was with obvious relief that he was transferred to the sleep unit. Overnight studies demonstrated severe sleep apnoea with both obstructive and central components. He was fitted with a nasal CPAP mask which greatly improved his nocturnal oxygenation but surgery was still considered too great a risk for such a patient. He was advised to continue nasal CPAP at night for the remainder of his time in hospital to familiarize himself with the procedure for home use. He was discharged from hospital following a thorough assessment of his heart disease and blood pressure, and placed on a strict weight reduction diet. The man was seen a month later in an outpatient clinic. He had reverted to his previous eating habits, put back on the small amount of weight lost during hospitalization and had discontinued the use of CPAP. He could not be convinced of its benefits and remains untreated for this serious condition.

Comment: An unmotivated patient with this sort of medical history can only expect further deterioration. It takes some time to become accustomed to CPAP, but failing that there should at least be an urgent reappraisal of one’s lifestyle.

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