I have been on the sleeping pill zopiclone for seven months and am wondering if I should come off it. I’m sleeping well but have started to get headaches. Do you have any advice?

Zopiclone is a Z drug – the other is zolpidem – and these should only be used for a short term, perhaps a few weeks.

Taking them for longer can lead to dependence. People may find they can’t sleep without them and suffer side-effects such as brain fog, poor memory, numbness and even anxiety and depression.

We also know that a tolerance builds up so that, in time, people need to use it more and more.

Anyone on a Z drug for more than a month or so should reduce their dose slowly due to the risk of withdrawal effects. These can include anxiety, the shakes, sweating and nausea.

Some patients tell me they feel their heart racing or that their old sleeping issue is coming back – but this is simply withdrawal. It’s important to speak to the GP to make a plan about how to stop.

We often do this over a period of weeks or months to make it as comfortable as possible. It can take more than one attempt.

For long-term sleeping problems, the recommended treatment is CBT-i, a specific form of cognitive behavioural therapy which tackles the thoughts and behaviours that cause and worsen insomnia.

For example, relaxation therapy or sleep restriction is used. Sleep restriction is where the patient is encouraged to limit their time in bed. They go to bed and get up at a set time, with a short window to begin with that’s increased.

It’s quite an involved process and a GP or therapist can help guide you through it. Or you can try an app such as Sleepio.

Sleep hygiene is often talked about. It means creating the best possible environment and mindset for sleeping with ideas like a tech-free room and not exercising before bed. This won’t cure your insomnia but is an important help alongside.

After tripping on a broken paving stone 18 months ago and fracturing my shoulder and arm I was diagnosed with moderate osteoporosis. I am 72 and have always eaten well and exercised. I’ve been recommended a drug called zoledronate but I’m worried as I’ve read it can cause some pretty nasty dental issues and I’ve had an extraction recently. What should I do?

Osteoporosis is a thinning of the bones that makes them weaker and more likely to break.

The aim of treatment is to prevent a fracture. Falls become more common as we age due to loss of muscle strength and stability and balance problems.

It can be quite serious. For example, hip fracture from osteoporosis will cause a permanent disability in around half of people who suffer one.

Osteoporosis is diagnosed with a DEXA scan. The result is given as a score which translates into various stages of bone thinning.

Whether treatment is recommended and what that treatment is depends on these results and a personal risk score calculated by a doctor, known as the fragility fracture score. Already having had a break will mean a higher score but it also depends on other factors such as age and family history. Treatment includes diet and exercise. Taking enough Vitamin D and calcium, both needed for healthy bones, is vital, as is adopting weight-bearing and muscle-strengthening exercises to support your bones.

The Royal Osteoporosis Society website (theros.org.uk) has helpful how-to exercise guides and diet advice.

Medication is important to strengthen the bones and there are a range, including HRT which may be suitable for some women in this case. All medications carry side effects and the dental complications of some osteoporosis drugs are important to weigh up if you need dental work. If you’ve had dental problems, it’s important to tell your doctor or nurse so they can work out the best treatment.

I have just returned from a holiday in Spain and suffered swelling in my feet and ankles after getting off the plane. This has been happening for years but tests show my circulation is fine. I am 71 and active. Is there any medication I could take? When it flares up it’s very sore and uncomfortable.

Swelling like this is known as oedema and though it can look unsightly, and feel uncomfortable, it’s generally harmless if all tests are normal.

When we sit for long periods, the movement of blood from the lower limbs back to the heart can slow. This allows fluid in the blood to leak out of the veins and into the surrounding tissues, which causes the swelling.

Movement of muscles in the legs and feet help to squeeze blood through the veins back to the heart more efficiently.

Oedema is worse for anyone with heart or vascular issues, so doctors do heart tests and other scans to check everything is ok. You may consider special socks for the plane. Compression stockings apply pressure to your legs, mimicking the muscles and aiding circulation. These are measured specifically for you and you can try different strengths and lengths to see what works and is comfortable.

We do sometimes prescribe water tablets – diuretics. It may be something that can be taken short-term to prevent these difficult symptoms on holiday.

Has hospital sent you home without care?

I heard an alarming story last week from the wife of a chap who was ‘turfed out’ of hospital after a horrific fall at home.

A few days after being admitted, despite the fact that he was practically unconscious having broken his hip, a hospital worker called claiming he said ‘he felt ready to come home’.

His wife agreed, of course. She asked if there would be any help. ‘Someone will come to assess,’ she was reassured. A care package – a bed downstairs, a commode and some help – would then be issued. But that never happened.

Luckily, she corralled friends to get a bed into the living room. After a few days of calling, the GP arranged a bedpan – but she still couldn’t get through to anyone from the hospital.

What a sorry tale. This scenario would fall under Discharge To Assess. Introduced in 2016, patients well enough to leave hospital but who need extra support are sent home and seen within days by an occupational health worker, who will then organise care. Clearly this doesn’t always happen.

If you’ve been in this situation, I’d like to hear from you. Write to me at the address above.

Heart attacks affect women too

I found myself irritated by an image that was posted on social media by the NHS’s Instagram account this week.

The picture was of an overweight man with hands clutching his chest, followed by part of a heart health campaign, designed to help people spot the signs of heart attacks. But we need to stop presenting heart attacks as a problem that only affects men.

It is well known that heart attacks often go hidden in women because there is an assumption – among patients and some doctors – that they are unique to men. It means women are slower to get vital treatment and are more likely to die from a heart attack.

Heart disease kills more than twice as many women in the UK as breast cancer. It may be time for the health campaign posters to reflect that.

The three-year-old British girl who was stabbed by the French playground knifeman on Thursday is out of surgery and watching television, France‘s president Emmanuel Macron has confirmed.

During a meeting with rescue workers in Annecy, Macron said of young Ettie Turner: ‘She is watching TV and [the attack] is just a bad memory already.

‘Doctors are optimistic,’ he added, though he said caution was still required.

Meanwhile, the ‘backpack hero’ who chased away Abdelmasih Hanoun, 31, has said his Catholic faith gave him the strength to fight the attacker.

Henri d’Ansleme, 24, told journalists he was undertaking a walking tour of France’s cathedrals when he came across a playground in Annecy and saw the man attack children in a stroller as their mother desperately tried to shield them.

Video footage shows him trying to block the assailant with one of his two backpacks, pursuing the man into the playground and throwing one of his bags at the attacker. 

Dubbed ‘the backpack hero’ (le héros au sac a dos) by media, the management and philosophy student suggested it was God’s will he was there to intervene.

‘All I know is that I was not there by chance. On my journey to the cathedrals I crossed paths with this man and I have acted instinctively. It was unthinkable to do nothing,’ the philosophy and management student told CNEWS.

Henri’s comments came as it emerged the knifeman responsible for the savage attack on the young children was seen lurking around the playground where it happened ‘every day for two months beforehand’.

The disturbing details about the build-up to Thursday’s atrocity came as self-styled Syrian-Christian Hanoun was remanded in custody while facing multiple attempted murder charges.

Meanwhile, Macron visited the alpine town on Friday and shook hands with Henri to thank him for his bravery.

The devout Catholic said he had felt a strong force inside him pushing him to act.

‘I let myself be guided by providence and the Virgin Mary. I said my adieu. They would decide what would happen,’ he said.

Henri said other young people had also pursued the attacker. ‘We tried to scare him and make clear he could not do what he wanted,’ he said. 

Henri shied away from the ‘hero’ label. He said he ‘tried to act as all French people should act, or would act.’ 

‘In that moment, you unplug your brain and react a bit like an animal by instinct,’ he told broadcaster BFMTV. ‘It was impossible for me to witness that without reacting.’

‘I am far from alone in having reacted. Many other people around started, like me, to run after him to try to scare him, push him away. And other people immediately went over to the children to take care of the injured.’

‘I remember there was also a municipal worker who arrived from the right with a large plastic shovel to try to hit him,’ Henri said.

Henri’s father François said that in phone conversation after the attack, his son ‘told me that the Syrian was incoherent, saying lots of strange things in different languages, invoking his father, his mother, all the Gods.’

‘In short, he was possessed by who knows what, but possessed by folly, that’s certain,’ the father told the Associated Press.

Henri’s father said he believed that his son’s dogged pursuit helped dissuade the attacker from stabbing more victims before police wrestled him to the ground.

‘He took a lot of risks when he wasn’t armed, with just his backpacks,’ the father said.

‘He didn’t stop running after him for many minutes, to stop him from coming back and massacring the kids even more. I think he prevented carnage by scaring him off. Really very courageous.’

François asked that their last name not be published, expressing concerns about their family being thrust suddenly and inadvertently into the public eye at a time of shock and outrage in France provoked by the viciousness of Thursday’s attack and the helplessness of its young victims.

He said he did show the disturbing video of the attack to his other children and his wife, and added that he and his wife had trouble sleeping even after learning that Henri was safe. ‘We thanked providence and his guardian angels,’ he said.

Asked about the suggestion that attacker may have been Christian, Henri said it made no sense.

The attacker had screamed ‘in the name of Jesus Christ’ and clinched onto a necklace with a crucifix as he launched his ‘abominable’ rampage in Annecy, a tourist hotspot in southeastern France.

Hanoun first targeted two French cousins named as Ennio and Alba, both two, and then attacked Ettie Turner, a three-year-old British girl on holiday with her parents, and Peter, a 22-month-old Dutch baby, before he was chased by locals and arrested.

Henri said: ‘It is profoundly unchristian to attack the vulnerable. The entire Christian civilisation on which our country is built is a knightly message to defend widows and orphans. I think that, on the contrary, something very bad inhabited him.’

The student said he had to revisit the gruesome details of the attack during a three-hour statement to police on Thursday. ‘I now have all these horrible images in my head. I need to try and turn that into something positive,’ he said.

He would continue his months-long walking tour and hoped to show social media followers ‘how the beauty of the cathedrals can nourish us and help us do the right thing’. ‘Because of these events, I will be able to reach more people. I thank heaven,’ he told BFM television.

It emerged today that despite being a failed asylum seeker who faced deportation, Hanoun – the assailant – was left to sleep rough in the Alpine city of Annecy.

‘He’d rest in a cardboard box at night, go swimming in Lake Annecy first thing in the morning, and then spent the day in the park,’ said an investigating source.

‘Parents and other people around the playground were used to seeing him sitting on a bench. He was often muttering or singing to himself, and became aggressive if anyone else tried to sit on the bench.’

Another witness who works on a lake pontoon told the Dauphiné Libéré news outlet that he saw Hanoun ‘every day for the two months preceding the attack.

‘He was dressed in black – black backpack, dark glasses, bearded, and he wore a headdress to protect him from the sun – it could be a t-shirt, this wasn’t a religious sign,’ the source said.

Earlier today, horrified residents gathered at the French playground where four preschool children were stabbed by a Syrian refugee, with one local man weeping uncontrollably and screaming ‘why was I not here yesterday’.

Devastated locals congregated in the town of Annecy to lay floral tributes and light candles for the four victims, including a three-year-old British girl, who were stabbed by Abdalmash Hanoun, 31, in a savage attack.

One local resident, Salih Ismajl, was overcome with emotion as he stood in front of the playground today and screamed: ‘Don’t touch the kids! Don’t touch the kids! Why was I not here yesterday!? Why was I not here?’

Today, French President Macron and his wife Brigitte visited Ettie’s family as well as the relatives of Ennio and Alba at the University Hospital in Grenoble, who have been left traumatised by yesterday’s savage attack.

The victims’ families, witnesses and locals in Annecy have been left reeling from the attack. Standing next to the scene of the brutal attack today, local resident Leo, 21, said: ‘We feel rage, incomprehension. I have the impression with how horrible it was. It affects us all.

‘We must all think about all these children, all these parents, who went through that yesterday.’

Distressing video shows Hanoun, a self-professed Christian, running into the small playground and repeatedly stabbing a toddler in his pram while his screaming mother tried to protect him from the attack. 

Further dramatic footage shows the recently divorced Hanoun later being chased across the park by locals and cops before he was shot by a police officer and pinned to the ground. 

The attack left the four children with serious stab injuries and medics at Grenoble hospital today said that Ennio and Albia remain in a ‘critical’ condition. 

Three-year-old Briton Ettie Turner, who is at the same hospital, is in a ‘stable’ condition as is Peter after being transferred to a specialist medical unit in Geneva.

Macron spent almost two hours with the three young victims at the hospital in Grenoble and their parents, while also speaking to the medics treating them. The French president spoke to Ettie’s parents, a source said.

A source close to the Elysee Palace told MailOnline: ‘The president spoke to the parents of the young English girl. The president’s wife Brigitte Macron was there as well.

‘They spoke with her family and to the families of the French children who were injured. The president was in a room with parents for quite a long time.’

Macron and Brigitte are now travelling an hour-and-a-half north to Annecy from Grenoble in a motorcade to meet with other victims, their families and the people who came to their aid following the attack which is not being treated as terror-related. 

Investigators are still trying to understand what Hanoun’s motives were for the onslaught. Annecy Prosecutor Line Bonnet-Mathis said in a tweet she was extending the suspect’s custody for further interrogation.

Horrified witnesses said mothers ran past them screaming ‘run, run’ in the aftermath of the frenzied attack, which was condemned by Macron as ‘absolute cowardice’. 

Witnesses said the knifeman, who was rejected for asylum in France four days before the onslaught, had begun attacking the preschool children while they were playing at a small playground in a scene of utter ‘carnage’. They said he had launched his onslaught on the toddlers because they were ‘easy targets’.

The four children targeted in the attack remain in intensive care today. 

French Prime Minister Elisabeth Borne said Friday that all four children underwent surgery for their life-threatening knife wounds and ‘are under constant medical surveillance.’ ‘Their situation is stable,’ she said. 

Line Bonnet-Mathis, the Annecy Prosecutor who is leading the investigation into the crimes, said: ‘We are dealing with very young victims whose state of health is still extremely fragile. All are in intensive care.’ 

One of the two pensioners injured in the attack said he was sitting on a bench by the park when Hanoun tried to stab him. 

‘I heard a commotion and then I saw someone being followed by people. He had a knife, I saw that he was behind me,’ Youssouf, 78, told Reuters. 

‘Suddenly he came in front of me and tried to stab me with his knife and I made a movement with my left arm to avoid the blow. Fortunately, I was injured slightly on the elbow.’ 

‘Afterwards I was treated by the fire brigade and the paramedics. He was still followed by civilians in front of me, so he ran to the left. Afterwards he attacked other people, I think, and was caught by the police and I heard the shot.’

The victim continued: ‘I felt like there was no reason for him to come and attack me. I stayed calm, I didn’t go after him, to chase him. I stayed quiet, still sitting, but he came like that and he probably wanted to make one more victim, to bother another person.

‘I’m calm but I can imagine the stress of family of the children and their loved ones or other children who saw the incident.’

Hanoun, who was recently divorced, had previously lived for 10 years in Sweden where he was granted refugee status in April, security sources and his ex-wife said. 

‘He called me around four months ago. He was living in a church,’ his ex-wife said on condition of anonymity, saying he had left Sweden because he had been unable to get Swedish nationality. 

He had applied for asylum in France but was rejected four days before launching his barbaric attack due to him already having refugee status in Sweden.

Horrific video of the attack shows Hanoun carrying a knife and clinching a necklace around his neck, which reportedly had a crucifix on it.

Wielding the knife, the Syrian refugee shouted ‘in the name of Jesus Christ’ as he ran towards a screaming mother whose little boy is in a stroller before a local man hits the attacker with his rucksack and chases him away. 

But the knifeman jumps into the playground again and runs towards the mother and her toddler. The woman screams and tries to protect her son with her body but Hanoun quickly moves around her and stabs the little boy twice.

The toddler can be seen screaming in pain as the mother and terrified parents scream for help as the attacker runs away again.

But the carnage continues. Hanoun runs back towards the child in the pram and stabs him again in front of his horrified mother before he is chased away by a local man who throws his bag at him. 

Further video taken minutes after the stabbing shows the attacker being chased by locals across the park. Parents can be heard in the background screaming for help for their injured children.

Soon afterwards, armed police arrived at the scene and chased the suspect before a shot is heard and the attacker falls to the ground before a desperate struggle with the cops. 

Hanoun was subdued and arrested for the attack that left four children and an adult seriously injured. The attacker was slightly injured by police and taken to hospital.

Describing the attack, a witness who gave his name as Ferdinand told BFM TV: ‘He jumped (in the playground), started shouting and then went towards the strollers, repeatedly hitting the little ones with a knife.

‘Mothers were crying, everybody was running,’ said George, another witness and owner of a nearby restaurant.

Another witness, who asked not to be named, said: ‘The man was shouting in English, and caused absolute panic when he started attacking the little ones. 

‘He wanted to hurt as many people as he could. He caused carnage. The young children were just easy targets.’

Another witness told Le Dauphine: ‘We saw a person attacking children playing games, small ones, obviously that was his target. After people tried to scare him, he walked away and the police intervened.’

Former Liverpool footballer Anthony Le Tallec said he saw a group of people running at him before a mother shouted at him: ‘Run, run, there is someone who is stabbing everyone all along the lake. They are stabbing children, run run!’ 

He continued: ‘I was so surprised, I continued and then suddenly the guy appeared in front of me, then I saw the police who were ten metres behind him but they hadn’t managed to get him yet. He was so near to me so I got out of the way.’ 

‘Mothers were crying, everybody was running,’ said George, owner of a nearby restaurant. 

An ice cream seller who works in the waterside park said he’d seen the attacker there several days earlier, looking out at the lake ringed by mountains. 

‘I had already seen him, he had been sitting on a bench for two to three days’, he told BFMTV.

‘He was looking at the lake like anyone else was looking at the lake,’ the witness said but added the suspect was sitting with ‘a trembling leg and a big black bag’.

France’s Prime Minister Elisabeth Borne, who travelled to Annecy yesterday, said Hanoun is a Syrian national who had been granted asylum in Sweden ten years ago. At the time of his application, he stated he was a Syrian Christian. 

He had entered France legally, Borne said, and was carrying Swedish identity documents and a Swedish driving license. He was not known to security agencies and has no criminal or psychiatric record, Borne said.

The local prosecutor leading the investigation said man’s motives were unknown but did not appear to be terrorism-related. He is under investigation for attempted murder and will undergo a psychiatric examination today. 

Hanoun had applied for asylum in France in November last year but police sources said his application was rejected four days ago on the grounds that he already had refugee status in Sweden. 

An investigating source said Hanoun is himself a married father of a three-year-old girl, and a devout Christian who carried a prayer book and a cross at the time of his arrest.

It was claimed that the suspect and his ex-wife, who lived in Trollhattan, north of Gothenberg, separated eight months ago and had not been in contact for four months. The pair had reportedly been training to be nurses.

Following the attack, Macron tweeted: ‘Attack of absolute cowardice this morning in a park in Annecy. Children and an adult are between life and death. 

‘The Nation is in shock. Our thoughts are with them as well as their families and the emergency services that mobilised.’ 

Several witnesses described Le Paquier park as an usually tranquil place popular with tourists for its stunning views of Lake Annecy and the mountains.

‘It’s a place where babysitters and parents take young children to play. I often see around 15 toddlers there in the morning, and the atmosphere is fantastic,’ said Yohan, who works at an ice-cream parlour just opposite the park.

France has been shocked by a number of violent incidents over the past few months, including the fatal stabbing last month of a nurse in the northern town of Reims. Also last month, a drunk driver accidentally killed three policemen.

Macron has denounced what he calls a ‘de-civilisation process’ in the country, while opposition lawmakers say his government has been too lax on law and order.

‘Nothing more abominable than to attack children,’ National Assembly speaker Yael Braun-Pivet said on Twitter. Parliament observed a minute of silence to mark the incident.

In recent years, France has suffered a series of traumatic attacks.

In 2012, a Franco-Algerian Islamic extremist named Mohamed Merah killed seven people including three children and a rabbi at a Jewish school during a shooting rampage in the southern city of Toulouse.

Most recently, the beheading of a teacher in broad daylight in 2020 near his school in a Paris suburb by a radicalised Chechen refugee led to shock and grief, as well as a national debate about the influence of radical Islam in deprived areas of the country.

Thursday’s attack is likely to spur greater scrutiny of France’s immigration and asylum policy, with right-wing politicians seizing on the suspected culprit’s identity as a refugee.

‘The investigation will determine what happened, but it seems like the culprit has the same profile that you see often in these attacks,’ the head of the right-wing Republicans party, Eric Ciotti, told reporters at parliament.

‘We need to draw conclusions without being naive, with strength and with a clear mind,’ he said.

Images showed police forensics at work today outside the headquarters of Loc Prud’homme, MP of the left-wing party La France Insoumise, in Villenave-d’Ornon. The building had been vandalised with far-right slogans. 

The leader of the far-right National Rally party, Marine Le Pen, wrote that she had learned the news with ‘dread and horror’.