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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 46889
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I’m suffering with sleeping and my mental health as I’m

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I’m suffering with sleeping and my mental health as I’m already have major health and I’m awaiting results for a rare blood cancer, my gp receptionist are extremely rude and obnoxious, putting many Obstacles in my way causing my anxiety to go through the roof.
JA: How long have you been dealing with this? Is there anything in particular that seems to make the symptoms better or worse?
Customer: Ive suffered from slight depression for a long time due many different health and social reasonamd have been on citaiopram for over 13 years I’m on 20 mg, but it’s not helping and I’m struggling to keep it together massively never felt so low to point I don’t want to be here and causing my stress for my family
JA: Anything else in your medical history you think the Doctor should know?
Customer: yes, I’m bleeding a lot, I’ve been diagnosed with kidney stones, and had a stent put in on the 10th of March, I had bleeding but it had stopped over a week ago but came back Sunday, I’m awaiting results from a jak2 mutation test which is due in on Thursday and have been told I’ve 99% got ET but we don’t know the serenity of the condition, I’ve got lupus (SLE), I’ve got rheumatoid Arthritis, osteopenia, (Parkinson syndrome, a vertigo like condition and buzzing in the ears constant, all due from having meningitis) I’ve also got a ileostomy.
Customer: replied 7 days ago.
I’m still awaiting a reply
Customer: replied 7 days ago.
I’ve been waiting over 30 minute for a the doctor to contact me
Customer: replied 7 days ago.
I’ve waiting over an 1,1/2 hrs

I've been working hard to find a Professional to assist you with your question, but sometimes finding the right Professional can take a little longer than expected.

I wonder whether you're ok with continuing to wait for an answer. If you are, please let me know and I will continue my search. If not, feel free to let me know and I will cancel this question for you.

Thank you!
Customer: replied 6 days ago.
Yes I would still like a response

I apologise as we have not yet been able to find a Professional to assist you. Do you wish for me to continue to search for someone to assist you or would you like for us to close your question at this time?

Thank you for your patience,

Following herbs can be tried for the depression with your present medication;

1) Ginkgo
2) St. John's wort

There are other therapies which can be tried as following;

1) Psychotherapy;
a) Cognitive-behavioral therapy (CBT)
b) Interpersonal therapy
c) Mindfulness-based cognitive therapy (MBC
d) Psychodynamic psychotherapy

2) Transcranial magnetic stimulation (TMS) has been approved for the treatment of the major depressive disorder.

3) Physical activity and exercise contribute to recovery from a major depressive disorder.

4) Stress reduction techniques.

5) Massage and physical therapy.

6) Acupuncture.

Do you have insomnia/inability to sleep?

Customer: replied 5 days ago.
Yes, I’ve not been able to sleep for months, I’m on life long steroids due to lupus which hasn’t helped, I’ve asked my GP for help but he refused to even discuss it with me, actually telling me to hurry up as he other people to talk to, between him and the reception staff I feel extremely intimidated by them to the point of not being able to talk or contact them myself.

Phytotherapy for the treatment of insomnia is an exciting new therapeutic option, which might benefit patients suffering from different degrees of insomnia. Insomnia or sleeplessness is a disorder characterized by difficulty initiating or maintaining sleep. It affects sleep quality and quantity leading to increased morbidity. Sleep disturbances are thought to be caused by abnormalities of the circadian system as indicated by misalignments of the endogenous circadian cycle and the sleep-wake cycle. Several contributory factors may be involved such as stress, health status, and medicines (e.g. caffeine).


Treating insomnia is a big challenge as the available medications are associated with several side-effects. Herbal medicines are being looked at as an ideal replacement for these medications. Among the ethnobotanicals used for sleep disorders, Valeriana officinalis and Ziziphus jujuba have been evaluated for pharmacological or clinical efficacy against insomnia. Sedative-hypnotics are the most commonly prescribed drugs for insomnia. Though not usually curative, they can provide symptomatic relief when used alone or adjunctively:

Short- and intermediate-acting benzodiazepines (triazolam, temazepam, estazolam)


Physical illness is uncommon with the sleep issue. An off and on sleeplessness need to dig the cause for underlying anxiety, depression or other related issues. A thorough evaluation by history is done to reach a conclusion. Accordingly, medical treatment is commenced. The precipitating factors can be;


1) depression,

2) anxiety,

3) sleep-wake schedule changes,

4) medications,

5) other sleep disorders,

6) medical conditions

7) work-related issues

8) family problem,

9) health events.


All these in isolation or in combination play problems in sleep issues. Good sleep cycle, handling the specific problem, counseling, cognitive-behavioral therapy, medications are employed for the treatment.


Following measures are helpful;


1) Avoid if you do;

a) caffeine or alcohol use,

b) environmental noise,

c) inappropriate room temperature,

d) watching TV in bed.

e) avoid large meals at dinner.


2) Relaxation techniques


3) Acupressure and acupuncture.


A study comparing zolpidem with CBT showed continued efficacy for the patients treated with CBT. Please see the reference;


Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. Sep 27 2004;164(17):1888-96. [Medline].



Dietary measures which are useful:


1) Avoid caffeinated beverages in the late afternoon or evening.


2) Avoid alcohol in the evening.


3) Avoid large meals near bedtime.


Acupressure on the Shenmen points of both wrists significantly decreased insomnia, with the benefit persisting for up to 2 weeks afterward. Please see the reference;


Sun JL, Sung MS, Huang MY, Cheng GC, Lin CC. Effectiveness of acupressure for residents of long-term care facilities with insomnia: a randomized controlled trial. Int J Nurs Stud. Jul 2010;47(7):798-805. [Medline].

The following is the guideline when using medications:


1) Try the lowest dose of the medication.


2) Use the medication for not more than 2-4 weeks in a single stretch.


3) Medications with a rapid onset of action, such as zolpidem or zaleplon, are preferable when the problem is falling asleep.


4) If the problem is staying asleep, temazepam, estazolam, flurazepam are more useful.


5) If one is depressed, an antidepressant with sedative properties, such as trazodone, mirtazapine, or amitriptyline, may be preferable.

Relaxation therapy is to take part in pleasurable activities like group sports, watching comedy serials, etc. People with insomnia often display high levels of arousal (physiologic and cognitive) at night and during the daytime. The various techniques which deactivate the arousal system are (1) progressive muscle relaxation, (2) biofeedback, and (3) imagery training and thoughts to stop.

Meditation relaxes the body muscles by concentrating on an object for 5-10 minutes once or twice a day.

In sleep restriction, therapy patients are allowed less time in bed which accumulates sleep which helps in sleep later. Once the insomnia is better, sleep restriction is also tapered off.

Stimulus control and sleep hygiene are:

1) to go to bed when sleepy only,

2) use the bed only for sleep and intimacy,

3) to get up at the same time each morning even if the sleep was inadequate in the night

4) avoid daytime naps.

Please read;


Following measures also may help:

Acupressure can help. Please see the reference;

Sun JL, Sung MS, Huang MY, Cheng GC, Lin CC. Effectiveness of acupressure for residents of long-term care facilities with insomnia: a randomized controlled trial. Int J Nurs Stud. 2010 Jul. 47(7):798-805. [Medline].


You can also try Cerêve Sleep System. The system consists of a bedside device controlled by software that cools and pumps fluid to a forehead pad that the patient wears throughout the night.

Anderson, P. FDA Approves New Device for Insomnia. Medscape Medical News. Available at

Wishing you a speedy resolution and all the very best in life.




" I sincerely hope that I have helped you and that I have earned my 5-star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen ( rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you!”.

Stay blessed.

Customer: replied 5 days ago.
I would also like to add due to coronavirus I’m self isolating as I’ve got lupus, my children have been shopping and can’t get any St. John’s wort or ginkgo, there is no herbal mood relievers or sleeping help
Customer: replied 5 days ago.
I’ve tried meditation apps, I’ve got audiable, which did help in the past, but my predesolone help been increased, I’ve got kidney and had 14days ago had a stent put in. I’m awaiting my results for a jak2 mutation forET

You seem to be anxious due to pandemic and due to waiting for JK2 mutation, which may further be aggravating the situation (as you may be apprehensive).

A positive rating would be highly appreciated for my time.

You are not charged extra for providing a positive rating.

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Wishing you all the very best in life.

Sending good, healthy vibes your way.

Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 46889
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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