Dear Dr. Roach: After I eat breakfast, I feel really tired and just want to lie down and take a nap. I am a 71-year-old woman in good health. Any ideas?
D.M.
We use the Latin-derived term “postprandial somnolence” (which just means “feeling sleepy after eating”) to describe this common situation.
Eating changes the mode of the autonomic nervous system (the part that is not under conscious control) from sympathetic (often called the “fight or flight” mode) to parasympathetic (“rest and digest”).
So, it is normal to feel a bit sleepy after eating. Some people are affected more than others, and meal size (but not meal composition) is a determinant of how powerful this response will be.
What is unusual is that you have this at breakfast, which is a time that most people are having a hormonal surge that tends to keep us awake, especially if you have just had a good night’s sleep.
The fact that you are having these symptoms after breakfast (since that’s all you mentioned) makes me concerned that you might not be sleeping well, and whenever I see that, I worry about medical conditions such as obstructive sleep apnea.
This is where people have very poor sleep due to frequent awakenings that they might be unaware of.
So, although I think you are just having a somewhat-greater-than-normal physiological response, the next time you visit your doctor, just have a chat about your sleeping habits.
Chest pain after eating, especially in people at risk for blockages in the arteries, is a much more serious and potentially dangerous condition requiring urgent evaluation.
From a pharmacological standpoint, many people use caffeine to get over any morning sleepiness.
Dear Dr. Roach: I’m a female in my 60s who gets about one cold sore a year. My mother had them, but my father did not, and neither did my brother.
My two children never get them, either. Is this an inherited condition that I got from my mother?
B.K.O.
What most people mean by “cold sore” is an outbreak of oral herpes (it’s also called a “fever blister”).
They aren’t an inherited condition, but most children will acquire the virus from their parents or siblings. It is possible to transmit the virus even when there are no symptoms.
Some people never get outbreaks after the initial infection; some people get them once or twice a year; still others may get them once or twice a month.
Sunlight, fever, stress and menstruation in women may cause them to recur.
It’s possible there may be a family predisposition toward greater recurrence frequency.
Dear Dr. Roach: I have been getting small cysts on my face. The dermatologist said they are sebaceous cysts, and injected them with a steroid, and they disappeared.
What causes these? Are there other treatments?
V.F.
This sounds like an epidermoid cyst, sometimes called a sebaceous cyst, which is formed from hair follicles and may be related to trauma or to an acnelike blister.
They are filled with skin protein and fat.
Your dermatologist chose the most usual treatment, injection with a steroid, and since they disappeared, I’d say that was the right treatment.
They can come back, in which case surgical removal may be necessary; and they can become infected, in which case they need to be opened and drained.
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.
