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Q1: You say in your article on insomnia that exercise disturbs routine. I always thought exercise, say a mile walk with the dog, was supposed to be an excellent aid to sleep. Is this where I have gone wrong - should I send the wife out with the pooch instead?! B. Tenter, York.

A1: Physical exercise during the day is an essential ingredient of any therapeutic package designed to treat insomnia. However exercise shouldn't be taken late in the evening as one of the tricks of going to sleep is to wind down in every department of life. The last meal shouldn't be too late or too heavy, one for the bed - the late nightcap - can be as tricky as one for the road. Alcohol very late at night helps someone to get to sleep but can produce the so called drunkard's false dawn two or three hours later. Most people who are sensitive to caffeine can enjoy their after lunch cup of coffee but some can't treat themselves to any caffeine-rich drinks from mid-morning onwards. Having coffee at night is a terrible mistake for an insomniac. Often people are so tired that they drop off to sleep despite the coffee but if they have had some they wake up in the early hours and can't get back to sleep again.

Keep up the exercise but at night before you go to bed either let your wife take the dog out for a mile, or do it yourself but don't venture beyond the shrubbery. Avoiding excess at night also applies to reading, the books chosen should be interesting but not overly stimulating and it is as well not to have a television in the bedroom. The bedroom must never become the family's debating chamber.

Q2: My mother has been taking sleeping pills for nine years now, since my father died, and really they do no good at all, she takes them at 10pm and is awake again by 3am. Can you suggest anything she can do to aid sleep rather than taking more or different pills? Mrs J Wood, Hornchurch.

A2: Sleep in the elderly is a complex problem. None of our physiological symptoms work as well as they did when younger so that frequently other troubles interfere with the sleep pattern. Chief among these are those affecting the joints and muscles. Few elderly people haven't troubles from arthritic joints and osteoporosis so that they suffer pain and discomfort after being in the same position for too long. Older people too are more likely to suffer from restless legs syndrome and other causes of fidgeting. Their difficulty in taking physical exercise during the day is a contributory factor to insomnia and coupled with this is a decreasing interest in the world so that they don't tire themselves out by thinking about politics, the household, the garden and the neighbourhood. This is only one of the many good reasons why people should keep socialised and active in the community for as long as possible. Many older people are depressed and depression with its gloomy, repetitive thoughts breeds insomnia.

The most important principles to remember are that if someone is managing five to six hours of sleep nightly they are probably getting enough sleep physiologically even if they are finding it psychologically unsatisfactory. Ideally seven or eight hours is the optimum amount but older people tend to doze during the day with twenty minutes snatched here and there. In old age there is some return to the sleep pattern of childhood, or of animals, so that people sleep irregularly during the 24 hours rather than in one fall swoop. As with babies a meal has a strong sedative effect. Your mother is in fact getting five hours sleep a night. Perhaps it would be a good idea in her case for her to go to bed rather later so that her time asleep would be closer to that of the rest of the household.

Other problems that affect older people's sleep are those related to both their breathing and their cardiovascular system. Older people are much more likely to snore and they are much more likely when they snore to suffer from the crescendo, intermittent loud snoring interspersed with periods of silence as breathing momentarily stops (sleep apnoea). Sleep apnoea cripples sleep.

I hope that you have discussed with your mother's doctor any other contributory problems she may have that makes sleep difficult. I assume that bladder troubles, muscle and joint difficulties have been excluded. It is also as well to enquire into the time of her last meal. Dinner shouldn't be too late but nor should someone be allowed to suffer from night time starvation. A snack or drink before bed can be helpful.

It may be that she is unduly depressed by an over-long bereavement. Some peoples' mood after they have been bereaved becomes stuck in the depressed phase and they may need anti-depressants rather than sleeping pills. It is a myth that the truly depressed, if old, don't respond to medication. Many do but it may take time and care to correct type and dose.

Q3: I used to have a sound sleep pattern. In fact it was so good that I slept through the great gales in the 1980s! But in the last four or so years I have developed a pattern of waking up several times a night, usually to go to the loo, and although I fall asleep rapidly enough afterwards I am also disturbed by changes in my body temperatore and find the two disturbances, loo and body temperature, mean I wake up int he morning feeling unrefreshed. Suggestions please. I am a 60-year-old woman. Dorothy, Birmingham.

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