A couple of glasses of wine or a few drinks in the evening will probably make you fall asleep faster than normal. Who among us hasn’t left the dishes for the next morning or neglected a skin-care routine after a dinner party or festive night out?But even if you thud into dreamland, there’s a good chance that too much alcohol will mean a fitful night of sleep. That’s because alcohol disrupts what’s known as your sleep architecture, the normal phases of deeper and lighter sleep we go through every night. A night of drinking can “fragment,” or interrupt, these patterns, experts say, and you may wake up several times as you ricochet through the usual stages of sleep.“You pay for it in the second half of the night,” said Dr. Jennifer Martin, a psychologist and professor of medicine at the University of California, Los Angeles. Alcohol is “initially sedating, but as it’s metabolized, it’s very activating.”Here’s how it breaks down. In the first half of the night, when fairly high levels of alcohol are still coursing through your bloodstream, you’ll probably sleep deeply and dreamlessly. One reason: In the brain, alcohol acts on gamma-aminobutyric acid, or GABA, a neurotransmitter that inhibits impulses between nerve cells and has a calming effect. Alcohol can also suppress rapid eye movement, or REM sleep, which is when most dreaming occurs.Later in the night, as alcohol levels drop, your brain kicks into overdrive. You may toss and turn as your body undergoes a rebound arousal. “As the levels decline, you’re going to get more issues with the fragmentation,” said Dr. R. Nisha Aurora, a member of the board of directors of the American Academy of Sleep Medicine. You’ll also probably have more vivid or stressful dreams and — because fitful sleep means that you’re waking up more regularly — you are more likely to remember them.Alcohol is also a diuretic, a substance that increases urine output, which means you may find yourself waking up to go to the bathroom. “You are going to have to pee more often,” said Dr. Bhanu Prakash Kolla, an associate professor of psychiatry and a consultant at the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minn. “Moderate amounts of alcohol, especially wine and spirits, have an early diuretic effect, especially in the elderly,” he added. It’s unclear whether the urge to urinate wakes you up, or if you’re just more attuned to your body in the second half of the night because you’re sleeping more fitfully.People may also snore more after they drink. Alcohol is a muscle relaxant and relaxes the muscles in your upper airways, disrupting normal breathing. Drinking can be especially dangerous for people with obstructive sleep apnea, who wake up many times during the night as their airways momentarily collapse.Most experts agree that drinking will mess with your sleep, no matter your age or gender. And because alcohol depresses the central nervous system, experts caution against using it with sleep aids such as Ambien, Tylenol PM, Benadryl or even supplements like melatonin.“Alcohol is a sedative,” said Dr. Ilene M. Rosen, a sleep medicine doctor and associate professor of medicine at the Perelman School of Medicine at the University of Pennsylvania. “I would not use any sedative hypnotic, whether over-the-counter or not, when you’re drinking alcohol.”Some people drink closer to bedtime to help them get to sleep. But that can start a dangerous cycle of more fragmented sleep, followed by heavier drinking. “I do see a lot of people who self-medicate for insomnia with alcohol, which is definitely not a good practice,” said Dr. Sabra Abbott, an assistant professor of neurology in sleep medicine at Northwestern University Feinberg School of Medicine. Sustained nightly drinking can establish worrying patterns that can persist even after people have stopped drinking.To help assess how alcohol may be affecting your sleep, experts recommend an alcohol-free reset period, or what Dr. Martin called “an alcohol holiday,” lasting at least two weeks. “It can be very eye-opening to appreciate how much alcohol affects your sleep,” she said. A lot of people who think they have insomnia, she said, may just be drinking too much or too close to bedtime.“It turns out that if they don’t drink, they sleep much better,” said Dr. Martin, who is also a spokeswoman for the American Academy of Sleep Medicine. After the “holiday,” she said, “they can just make a more informed decision about how much — and how often — they consume alcohol.”Experts also suggest building in a buffer zone of at least a few hours between drinking and bedtime. A nightcap is not your friend. “It’s probably OK to have a glass of wine with dinner four hours before bed,” Dr. Abbott said. Or maybe limit your drinking to happy hour or the appetizer course.Alcohol can mess with your morning routine, too. “People may turn to stimulants” like caffeine, drinking coffee well into the afternoon, said Dr. Armeen Poor, a pulmonary and critical care physician at Metropolitan Hospital Center in New York and clinical assistant professor of medicine at New York Medical College.“That makes it harder to fall asleep at night,” he said. “And then you need more of that sedative, and then it just goes around and around and around.”

The “vampire hormone” can act like a dose of sunset, tricking your body into feeling like it’s time to sleep. Most people think of melatonin as a natural nod-off aid, kind of like chamomile tea in pill form. Even the name of the popular dietary supplement sounds sleepy — that long “o” sound almost makes you yawn mid-word. But melatonin is also a hormone that our brains naturally produce, and hormones, even in minuscule amounts, can have potent effects throughout the body.“There are some clinical uses for it, but not the way that it’s marketed and used by the vast majority of the general public,” said Jennifer Martin, a psychologist and professor of medicine at the University of California, Los Angeles.Experts strongly urge people to consult their doctor or a sleep specialist before taking melatonin, in part because the supplement does not address many underlying health problems that may be disrupting sleep. Anxiety can cause insomnia, as can a host of other potentially serious ailments, such as sleep apnea, restless legs syndrome or mood disorders like depression, that may require medical treatment.Melatonin, however, is relatively inexpensive and readily available at local pharmacies in the United States (in other countries it typically requires a prescription), and many people will go out and buy it on their own. So what’s the best approach to taking melatonin? Here’s what experts had to say.How does melatonin work?During the day, the brain’s pea-sized pineal gland remains inactive. A few hours before our natural sleep time, as it starts to get dark outside and the light entering our retina fades, the gland switches on to flood the brain with melatonin.“Melatonin is sometimes called the ‘hormone of darkness’ or ‘vampire hormone,’” because it comes out at night, said Matthew Walker, a professor of neuroscience and psychology at the University of California, Berkeley, and the author of the book “Why We Sleep.” As levels of melatonin rise, levels of cortisol, the stress hormone, fall. Respiration slows. Soon, our eyelids begin to droop.Instead of a lights-out trigger, melatonin acts more like a dimmer switch, turning the day functions off and switching night functions on. So taking a melatonin supplement is sort of like taking a dose of sunset, tricking your body into feeling like it’s nighttime. It doesn’t put you to sleep as much as it tells the body that it’s time to sleep.“It may take several hours,” said Dr. Ilene M. Rosen, a sleep medicine doctor and associate professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, “which is what I think is the misconception about how melatonin is used.”Melatonin may make you feel a little drowsier when you take it, but it has a bigger impact on regulating the timing of your overall sleep-wake cycle and helping to set the circadian clock, the roughly 24-hour internal timekeeper that tells your body what time of day it is and syncs it with the outside world.“The impact it has on our sleep depends on the time of day that you take it,” said Dr. Martin, who is also a spokeswoman for the American Academy of Sleep Medicine. “If you took a sleeping pill in the middle of the day, it would make you feel sleepy. If you took melatonin in the middle of the day, it doesn’t really have that effect.”Hypnotic drugs like Ambien or Benadryl generally cause people to feel sleepy right away, and the sedation effect of those medications “far exceeds that which they obtain from melatonin,” said Dr. Alon Y. Avidan, a professor of neurology and director of the Sleep Disorders Center at U.C.L.A. How effective is melatonin?In one analysis published in 2013 in PLOS One, which combined results from 19 studies involving 1,683 men and women, people who took melatonin supplements fell asleep seven minutes faster and increased overall sleep time by eight minutes. That may not sound like much, but there was a lot of individual variation, and researchers found that melatonin also improved overall sleep quality, including people’s ability to wake up feeling refreshed.But there’s no guarantee that melatonin will work for you.Dr. Sabra Abbott, an assistant professor of neurology in sleep medicine at Northwestern University Feinberg School of Medicine, said the most common complaint she hears from patients is “I tried melatonin and it didn’t work.” Many also feel hung over or groggy the next morning. Dr. Martin said that in many studies, melatonin does not work any better than a placebo but added, “One caveat I always like to mention, though, is that placebos work pretty well for insomnia.”What about dosage?We naturally make melatonin in our brains, but only in picogram amounts, or one trillionth of a gram, which Dr. Rosen described as “a whiff of it coming out at dusk.” Over-the-counter melatonin supplements come in much higher milligram doses, or a thousandth of a gram. That’s a big difference.Many experts recommend starting with the smallest available dosage — 0.5 milligrams to 1 milligram, 30 minutes to an hour before bedtime — and seeing how you do from there. If that has no effect, the dose can be gradually increased.“If you try a dose, stick to it for a few days before you make an adjustment,” Dr. Martin said. “It’s one of those things that may not happen overnight.”“Keep a close eye on how you feel the next day,” Dr. Abbott said. “Feeling groggy or hung over is a sign that the dose is probably too high.”Are there side effects?The good news: In the short term, at least, melatonin is unlikely to do any harm.“Compared to most other sleeping pills, the side-effect profile is much better,” and it’s not going to be addictive, said Dr. Bhanu Prakash Kolla, an associate professor of psychiatry and a consultant at the Center for Sleep Medicine at the Mayo Clinic. But because melatonin can cause drowsiness, the Mayo Clinic warns that you shouldn’t drive or operate machinery within five hours of taking it.Does melatonin affect our dreams?“Far and away, the most common side effect that I have patients report to me is that their dreams just become much more vivid,” Dr. Abbott said. Scientists aren’t sure why that happens.Dr. Kolla has also seen patients who have nightmares or disruptive dreams, which are also common with sleeping pills. “In that case, you want to try to lower the dose,” he said. “Or, if it’s too problematic, stop.”How do doctors use melatonin?Sleep doctors may use melatonin to help patients with circadian rhythm disorders regulate their sleep-wake cycles. For example, during the pandemic, Dr. Avidan said, “we’ve seen those people who become super night owls” unable to fall asleep until 2 or 3 a.m.Experts also suggest people use a bright light in the mornings to help them wake up, which has “alerting properties and can suppress any remaining melatonin production,” said Dr. Abbott.Should you take melatonin for jet lag?Jet lag is a circadian rhythm disorder, albeit a temporary one, so melatonin may help. To alleviate the worst effects, doctors recommend consulting one of several online calculators available, which ask you for your destination and arrival points, your flight time and your normal sleep patterns. Two sites that Dr. Avidan recommends are Jet Lag Rooster or the calculator from Fleet Street Clinic.“They’re trying to tell you when to take the melatonin so your body knows: ‘Oh, it’s dusk where I’m going,’” Dr. Rosen said, explaining how you can use the supplement before your trip to readjust your body clock.How do you pick a reliable brand of melatonin?Like other dietary supplements, melatonin is not regulated by the Food and Drug Administration, which means there may be wide variation among products. A study published in the Journal of Clinical Sleep Medicine found that the content of more than 70 percent of melatonin supplements varied widely from their label claims. The concentration ranged from 83 percent less than the amount listed to 478 percent more.Dr. Kolla advised looking for a GLP (good laboratory practice) or GMP (good manufacturing practice) label, which refers to federal regulations designed to affirm a product has the advertised quality and purity. “You really don’t know what you’re getting, so you’re trusting the manufacturer,” he said. Melatonin comes in pills, gummies or liquid; the choice comes down to personal preference, he added.What are alternatives for chronic insomnia?Sleep doctors strongly urge people with chronic insomnia to seek out cognitive behavioral therapy, a short-term psychological treatment that can help get to the root of the problem.“If you give melatonin to a patient and you don’t complement it with behavioral therapy for insomnia, you may not necessarily see the effects that you’re looking for,” Dr. Avidan said.Many common behaviors can also make it harder for us to fall — and stay — asleep, including using our phones near bedtime, which can hamper natural melatonin production. Meditation may help, as can warm showers and cool bedrooms, or giving up caffeine and alcohol. “There are a lot of other things people could do to help themselves sleep better,” Dr. Martin said. “They’re just harder.”

Yes, you can get “flurona.” But it’s probably not as bad as it sounds.Reports about dual infection with the flu virus and the coronavirus have been making sensational headlines recently. Last week Israel confirmed its first case of “flurona,” in an unvaccinated woman, followed by a growing number of cases in children in the United States. None were seriously ill, but the name “flurona” stuck.“It sounds like ‘sharknado,’” Dr. Saad B. Omer, the director of the Yale Institute for Global Health, said. “But it’s not a known medical term.”As flu season sets in and the Omicron variant continues to surge, how worried should we be? We spoke to experts to better understand what it could mean to test positive for both infections. Here’s what we learned.Why am I just hearing about this now?People have been testing positive for both Covid-19 and influenza, or flu, since the pandemic began.From late January to late March 2020, researchers in China found almost 100 cases of patients testing positive for both illnesses in Wuhan. The Atlantic reported on a family in Queens that tested positive for both infections that February. And researchers in Barcelona published a paper in May 2020 describing four people with both illnesses in the early months of the pandemic.At the time, before vaccines were available, such dual infections, or what infectious disease experts call co-infections, appeared to be uncommon. A spring 2020 study in New York City, for instance, found that after about 1,200 Covid-19 patients were tested for other respiratory viruses, such as those causing influenza or the common cold, just 36, or less than 3 percent, had simultaneous infections. Last winter was also a notably subdued cold and flu season, with fewer people socializing and many wearing masks.“The reason we haven’t talked about it much is that it’s not been clinically a challenge yet,” said Dr. Jonathan D. Grein, an infectious disease physician and the director of hospital epidemiology at Cedars Sinai Medical Center. “We anticipate that as flu becomes more prevalent, we will see more co-infections.” If it becomes a serious problem, experts expect to know a lot more about it in the coming months.Will co-infection make me twice as sick?A co-infection doesn’t immediately mean that a patient will be doubly sick. A strong immune response may actually help the body fight off pathogens of all types, so one infection could stimulate some additional protection.“An infection to one might help to aid your immune response to another,” Dr. Grein said, “because it’s activating that same immune response that’s going to be effective in fighting both.”Still, scientists don’t know for sure yet, because so few people have tested positive for both Covid-19 and influenza. But judging from past trends, doctors are not overly worried.“The majority of people who have influenza do just fine. The majority of people who have Covid do just fine, especially if they’re vaccinated,” said Dr. Andrew D. Badley, an infectious disease specialist and the chair of the SARS-CoV-2 Covid-19 Task Force at the Mayo Clinic. “It is hard to predict,” he continued, “but we expect that the majority of people who are co-infected with the two viruses will also do just fine.”But as Dr. Badley and other experts pointed out, it’s generally better to have one infection rather than two. There’s more chance for complications with two infections, and it’s a bigger strain on the body.“The human immune system can create antibodies for multiple pathogens simultaneously,” said Dr. Andrew Noymer, an epidemiologist and associate professor of population health and disease prevention at the University of California, Irvine, who studies influenza.“But given the choice between being infected with one or two, I would always choose one,” he continued, adding, “I can’t tell you that two is so much worse than one, but the less viral threats, the better.”Who is most susceptible?Dr. Omer, who is also a professor of infectious disease and epidemiology at Yale, identified two groups he thought could be most susceptible to co-infection.First: unvaccinated adults. “Based on previous work on vaccinations, people who refuse one vaccine might refuse others as well,” he said. He said he expected there to be a “significant overlap between people who refuse both vaccines.”Second: children, especially those under 5, who are too young to get vaccinated against Covid-19. Kids are also petri dishes, as any parent will tell you, and have lived through fewer cycles of the flu. So even if a child got a flu shot, Dr. Omer said, “their library of protection is narrow” against the many viral flu strains that can emerge each year.What are the risks for the frail or elderly?Experts agreed that a patient who is already vulnerable to severe disease from one illness may suffer even more if doubly infected.“It is probable that those people who would have had a bad outcome from flu will have a very bad outcome from the combination of flu and Covid,” Dr. Badley said.What are the risks for children?Pediatricians were optimistic that “flurona” would not overwhelm most children. That’s because kids may be more likely than adults to get multiple infections at the same time.“It’s not that surprising to most of the people who work in pediatrics,” said Dr. Frank Esper, a pediatric infectious disease physician at Cleveland Clinic Children’s Hospital. “We see co-infections all the time.”The Coronavirus Pandemic: Key Things to KnowCard 1 of 6The global surge.

An unusual incident at a hockey game may have been lifesaving for one staff member with a suspicious skin mole.In October, Nadia Popovici, a Seattle Kraken hockey fan, went to a game with her parents. She spotted a strange-looking mole on the neck of an assistant equipment manager for the opposing team, the Vancouver Canucks, and typed out a message to him on her phone.“The mole on the back of your neck is possibly cancerous. Please go see a doctor!” the message read, with the words “mole,” “cancer” and “doctor” colored bright red.Her message may have saved his life. It turned out to be a melanoma, a particularly deadly type of skin cancer that, because it was detected early, could be removed before it had spread.“She took me out of a slow fire,” the assistant manager, Brian Hamilton, said at a recent news conference.Skin cancer is common, but often survivable. Basal and squamous cell carcinomas, by far the most common types of skin cancer, can be extraordinarily disfiguring but are rarely fatal.Melanoma is a different story. It accounts for just about 1 percent of all diagnosed skin cancers, but causes the vast majority of deaths. In 2021, the American Cancer Society estimated that doctors would diagnose about 106,110 new melanomas in the United States, and that about 7,180 people would die of the disease. The risk increases with age.Early detection can lead to effective treatment. The five-year survival rate for “thin melanoma,” Stage 1, when the cancer is less than one millimeter thick, is 99 percent, according to the American Cancer Society. Once it has spread to distant organs, Stage 4, the survival drops to 27 percent.“If you miss the beginnings of this one, you might actually miss the opportunity to save the person’s life,” said Dr. Allan C. Halpern, the chief of dermatology service at Memorial Sloan Kettering Cancer Center.So in light of the hockey “miracle” — and the new year — consider this your guide to setting some healthy skin care habits for 2022.1. Above all, look for … weirdIf you see something on your skin that is new, changing, not healing or doesn’t seem right, get it checked out by a doctor as soon as possible.“What we often refer to is the ‘ugly duckling sign,’” Dr. Halpern, a vice president of the Skin Cancer Foundation, said. “If it just looks different than everything else, get it checked out.”The Skin Cancer Foundation, founded in 1979, has long recommended an “ABCDE” test for worrisome lesions. It is a mnemonic device to check what to look for: A for asymmetry, when one half doesn’t match the other; B for an irregular border; C for colors that might be different from one another; D for a large diameter, or anything approaching the size of a Cheerio or a pencil eraser; and E for evolving, meaning that it changes over time.Those recommendations are still useful, but they may be somewhat limiting. “Many melanomas and most nonmelanoma skin cancers don’t fall under the ABCDE pattern,” the foundation reported in its journal in 2019. “When we educate people about the warning signs of skin cancer, we often hear from them, ‘Mine didn’t look like that.’”Many dermatologists recommend people look for things that feel out of the ordinary. Is it new? Is it growing? Is it refusing to heal? Those may all be indications that it’s time to see a doctor.Dr. Halpern said to look for any unusual lesions that make you anxious. “People have a sense of normal,” he said. “It’s really important not to downplay people’s visceral knowledge of normal versus out of the ordinary.”2. Set a regular scan reminderYou won’t know what’s weird if you don’t carve out time to look. The Cleveland Clinic recommends a monthly scan, though some doctors say you can opt for a quarterly skin check instead.“If you don’t examine yourself at least once a month, you don’t have a good mental memory of what you look like, so you won’t be able to spot change,” Dr. Halpern said.To scan, stand in front of a full-length mirror; have a hand mirror on deck for hard-to-reach places. Start systematically, from the top of your head down. Don’t forget your scalp and neck, or under the nails. The Skin Cancer Foundation has a guide, and the American Academy of Dermatology Association has a video tutorial.And remember, look for weird. If there’s a mole that you think looks out of the ordinary, get it checked out. You can also take pictures of your moles so you can compare them on your next scan. If you’re noticing changes, or if you develop a sore that does not heal, call a dermatologist.3. Do it with a buddyA recent study found that married people are more likely than the unmarried to get timely diagnosis and treatment for malignant skin cancer. That may be because they have someone else who sees them almost every day, and who might notice something unusual. Spouses may also urge their partner to visit a doctor.“The number of times that I’ll see someone at the office who comes in and either they, or their significant other, has said: ‘That’s not just like it was on you before. I can’t say why it is, but it’s just different,’” said Dr. Aaron Mangold, the divisional chair of clinical dermatology at the Mayo Clinic.If you live alone, a buddy system might work. Consider setting up a monthly reminder with a roommate or a regular “mole check” evening with a close friend.4. Know your risk factorsYour skin, and your personal history, affect how often you have to check. If you’re at high risk of skin cancer, you should have a different relationship to your dermatologist and your moles.People who have a family history of melanoma are more likely to develop the disease. “If you’ve gotten a lot of blistering sunburns, maybe five by the time you’re 18,” or used a tanning bed, you are at increased risk, Dr. Deborah S. Sarnoff, the president of the Skin Cancer Foundation, said. “That really bumps it up, the way smoking bumps up lung cancer.”Your skin color plays a role, too. People with light skin, blond or red hair, blue eyes, or many freckles and moles are more prone to developing skin cancer than people of color — it’s more than 20 percent more common in white people than Black people, according to the American Cancer Society. That’s because most skin cancers are sun related, and darker skin is less at risk for sun-induced cancers.In people of all races, however, skin cancers can also present in places that do not regularly get sun exposure, like the hands or soles of their feet, the mucous membranes (gums, lips) and the nail beds. These cancers may be more deadly, because they are often diagnosed at a later stage. And although melanoma is more common when you’re older, young people can get skin cancer, too. In fact, it is one of the most common cancers in people younger than 30, especially young women. The Cleveland Clinic says you should “always be suspicious of a new mole that develops after the age of 30.” Many are harmless, but it’s good to check with a dermatologist, just to be safe.5. If you think you have reason to be worried, see a dermatologistCome to the doctor’s appointment prepared to point out any unusual spots you’ve noticed, and to have your entire body checked. “It is every square centimeter of skin,” said Dr. Ashwani Rajput, the director of the Johns Hopkins Kimmel Cancer Center for the Washington, D.C., region, who treats patients with melanoma.The Skin Cancer Foundation recommends you remove makeup before your exam, if you wear any, so it will be easier to spot suspicious moles.“Leave any embarrassment at the door,” Dr. Sarnoff said, adding, “You’re there to have your skin looked at.”A screening can take up to 30 minutes. A doctor who finds a mole that might be cancerous will often numb the area and then remove some or all of it for a biopsy. The doctor will share the results and discuss next steps with you if the biopsy returns a positive cancer result.“The overwhelming majority of these visits do end up being covered by insurance,” Dr. Halpern said, especially if you are at high risk or there is cause for concern.