Dear Doctors: I am a 57-year-old man, and ever since the pandemic started, I have had trouble getting enough sleep. I sometimes use a sleep medication, and it has been helpful. But I've been reading that using sleep meds can increase your risk of developing dementia. Is this true?

Dear Reader: When it comes to not getting enough sleep each night, you are far from alone. According to data collected by the Centers for Disease Control and Prevention, up to one-third of adults in the United States share your struggle.

It's not all that surprising, then, to learn that more than 26 million people over the age of 18 use sleep medications at least a few times each month. That's more than 8% of the population. For older adults, the usage is higher -- close to 12%. This makes any possible link between sleep medications and dementia risk an important consideration.

The question of whether sleep medications can affect cognition has been an area of inquiry for several years. Although the research appears to draw a connection between the heavy use of sleep medications and an increase in dementia risk, the studies come with a big caveat. A study published in 2020 examined eight years of health data collected from 6,300 adults over the age of 65. The researchers found that those who regularly used sleep medications had an increased risk of developing dementia. However, problems with sleep can often be an early symptom of dementia. That made it impossible to say for sure if the use of sleep medications played a role in the development of dementia, or if their use was merely highlighting the onset of the condition.

Another study, published earlier this year, looked at more than 3,000 men and women with an average age of 74. None of them had been diagnosed with dementia. Over the course of 15 years, 20% of the participants developed dementia. Of those who reported frequent or nightly use of medications, a measurable increase in dementia risk was seen. It's important to note that the unanswered question of the previous study persists. That is, whether the sleep medications themselves were linked to dementia, or if they served to highlight the initial symptoms of the early stages of dementia.

The medications most associated with greater risk of dementia in both studies are a class of drugs known as benzodiazepines. Researchers suspect that these medications may adversely affect chemicals in the brain that play a role in learning and memory. More research is needed to refine the results of these studies. Meanwhile, neither of the studies found a connection between the occasional use of sleep medications and an effect on dementia risk.

Living with a sleep deficit doesn't just leave you feeling tired and groggy the next day; it can also play a role in developing health problems such as high blood pressure, heart disease, kidney disease, diabetes, stroke, obesity and depression. It would be wise for you to talk about your sleep difficulties and use of sleep medications with your health care provider.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I have noticed recent advertisements for ashwagandha, which is supposed to be useful for stress management. I am looking for guidance on this supplement, including whether it works and if there are any side effects. Are there dosage guidelines?

Dear Reader: Ashwagandha is certainly having its moment. It is an evergreen shrub that grows in certain regions of India, Africa and the Middle East, and it has chemical properties that are believed to help manage stress. In recent years, mentions of ashwagandha have exploded on social media. And small wonder. National surveys indicate that half to three-fourths of people living in the United States report suffering from chronic stress and anxiety.

The use of ashwagandha as a nerve tonic springs from Ayurveda, a form of traditional Indian medicine that dates back 3,000 years. Due to the complex chemical properties of its leaves and roots, the herb is considered to be an adaptogen. This term was coined in 1947 by a Russian scientist, who defined it as a natural substance that helps the body manage adverse conditions related to stress.

Ashwagandha is said to relieve anxiety, lower blood pressure, ease fatigue, aid in sleep and bolster immune health. However, at this time, most of the information about the herb's efficacy is anecdotal. A handful of recent studies have shown promising results regarding its potential as a stress reliever, but these have been quite small. Larger, longer and more rigorous studies are needed to draw firm conclusions.

Some people who use ashwagandha report side effects such as stomach upset, loose bowel movements or diarrhea and nausea. For the most part, though, it is considered to be safe for regular use over the course of three months. Information on prolonged use is not available.

Certain groups, including people with thyroid conditions, autoimmune disorders, hormone-sensitive prostate cancers and pregnant women should avoid the herb.

Regarding your question about dosage, it's tricky. Ashwagandha is widely available as capsules, tablets, teas and infusions. These are made from the leaves, the roots or both. However, the shrub is chemically quite complex, and the leaves and roots contain different compounds. Add in the lack of oversight in the nutritional supplement market in the U.S., and it is difficult to know what, exactly, each ashwagandha product contains. As always when using any dietary supplements, talk to your health care provider. If you take medication, ask if adverse interactions are a danger.

As the billion-dollar global anti-stress industry proves, there are no quick fixes. In working with our own patients who suffer from stress and anxiety, we counsel cultivating internal strength and resolve. That means adopting the habits and behaviors we have written about in these columns over the years. That includes regular exercise, good nutrition, adequate sleep, robust social connections and calming practices such as yoga or meditation.

Ashwagandha can certainly have a place in your life. However, it will be most useful as part of a larger program that you sustain from day to day, month to month and year to year.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: We recently relocated for my husband's job. It's hotter here and a lot more humid than our previous home. All three of our children, including the baby, are suddenly dealing with heat rash. Why does that happen? How can we help them avoid it?

Dear Reader: It has been a long, hot summer, and we suspect you are not alone in dealing with the unpleasant realities of heat rash. The condition is also sometimes referred to prickly heat, a succinct summary of the symptoms and their root cause. In medical language, it is known as miliaria. These terms all refer to the patches of small, raised bumps that develop when someone's sweat glands and sweat ducts become blocked, often due to heat and humidity. These blockages can occur at the surface of the skin, or deeper within the sweat duct.

When your sweat ducts or glands become blocked, perspiration can't spread out across the surface of the skin. Instead, the moisture backs up within the epidermis. This leads to irritation and inflammation and a constellation of other symptoms. These can include itchiness that can become severe, a persistent prickling or burning sensation and swelling. In pale skin, the bumps of heat rash typically appear as areas of reddening. In darker skin, a change in skin color in the affected area may not be apparent.

The blockage that leads to heat rash is caused by a persistent layer of perspiration, often mixed with the skin's natural oils. It occurs when sweat becomes trapped, often due to high humidity, which prevents adequate evaporation. Babies and young children, whose sweat glands have not yet fully developed, are particularly susceptible to heat rash. So are adults who are overweight or obese, and anyone who is overdressed in hot and humid conditions.

Common sites of the condition include the backs of the knees, beneath the breasts, the armpits, creases of the elbows, neck, inner thighs, back, waist and groin area.

While uncomfortable, heat rash is usually harmless. Treatment focuses on cooling the affected area and keeping it clean. This can be done with a moist cloth or a cool bath or shower.

Dress your children in a single layer of loose-fitting clothing, which helps eliminate friction. Natural fibers, like cotton and linen, are more breathable than synthetics. Shorts and sleeveless tops are helpful. So is proper ventilation. This same approach to preventing heat rash applies to adults, too. When it comes to your baby, do frequent diaper checks, and change it as soon as it is wet or soiled.

Areas of persistent itchiness in someone with heat rash can be soothed with over-the-counter ointments and lotions meant to treat rash.

As with any site of inflammation, infection is possible. This can cause sweat ducts with deeper blockages to develop small pockets of pus. If this occurs, it is important to seek medical help in dealing with the infection. When treated, heat rash goes away in a day or two. If the condition persists or appears to get worse, see your health care provider.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)