DEAR DR. ROACH: I wonder if we can trust the health guidelines coming from government agencies. How will doctors make recommendations if the guidelines may not be scientifically rigorous? — T.D.

ANSWER: For many decades, the recommendations from the Centers for Disease Control, the National Institutes of Health, the United States Food and Drug Administration, and other governmental bodies have been based on sound science with some of the best experts in the world collaborating to give trustworthy advice. There have been some lapses and changes in the understanding of the science so that recommendations change to keep up with the latest research.

With recent and dramatic changes in funding, personnel and philosophy, it’s more important than ever for practicing physicians to look at all the available evidence. However, it is unreasonable to expect a busy practitioner to read all the primary literature in all the areas of medicine. Fortunately, there are abundant resources to help.

Scientific societies, like the American College of Physicians, the American Academy of Pediatrics, and the American College of Obstetrics and Gynecology, have stepped up to fill a void in trustworthy information. Other countries, especially Canada and European countries, have similar panels to evaluate and summarize the primary evidence and provide recommendations.

The World Health Organization has many resources as well. When there is a broad consensus, these guidelines are most likely to represent the true state of scientific understanding.

The University of Minnesota spearheads a project to create a comprehensive database that helps inform clinicians about vaccine science to help counter rampant misinformation (which can be found at CIDRAP.UMN.edu/vaccine-integrity-project).

Your own doctor (and your child’s) remains the most important resource, but clinicians need to stay up-to-date with reliable information.

DEAR DR. ROACH: I am 71 and have been using zolpidem nightly for over 20 years. I started using it because of nightmares or panic about things around 2 a.m. Every time I try to quit, I have a miserable attempt at sleeping and give up the effort. Is there another drug that can help ease me off zolpidem without the sleepless nights? — T.Y.

ANSWER: Zolpidem (Ambien) is a very effective sleep medication, but it has several potential problems, especially for a person in their 70s. I am very concerned about falls as I have personally seen too many people — family members as well as patients — begin a downward spiral after a fall with an injury.

Zolpidem, like all sleeping medications, roughly doubles the risk of falls in older adults. This class of drugs can also cause cognitive impairment, sedation, and loss of balance (hence the risk for falls). Physical and psychological dependence may develop quickly with zolpidem and similar drugs, which is why it can be so hard to stop.

I am concerned about your report of nightmares and panic, and I wonder if your problem isn’t insomnia. You may have a mood disorder such as generalized anxiety or a panic disorder with insomnia. This may require a different type of treatment, such as an SSRI, which is not a sleep medicine at all.

Ideally, I recommend a treatment that does not emphasize medications for sleep. Cognitive behavioral therapy for insomnia is my first choice, but I also recommend that you consult with a sleep medicine expert, who might prescribe different medication short-term while you are learning the CBT-I techniques that should help you sleep without meds.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved