Dear Doctor: My wife's uncle, who lives with us, is 76 and obese. I have noticed he sleeps an awful lot -- to me, anyway. He sleeps approximately five or six hours a night and then later while sitting on the couch. He frequently takes afternoon naps or will fall asleep while reading and will also fall asleep while watching TV at night. My wife doesn't seem to be concerned. Should we be?

Dear Reader: The quick answer is yes, you should be worried. I wouldn't assume that your wife's uncle's sleepiness is a function of age. I don't know the specifics about his past medical conditions or other aspects of his overall health, but the details you provide make me suspect sleep apnea.

Obstructive sleep apnea is a common disorder, affecting 15 percent of adult males, that occurs when people are sleeping. The biggest risk factors are obesity, being male and older age. Your wife's uncle has all three of these. In a 2000 study of 700 adults, published in the Journal of the American Medical Association, every 10 percent increase in weight is associated with a sixfold increase in the rate of sleep apnea. With the rates of obesity increasing over the last 30 years, the rates of sleep apnea have also increased.

In sleep apnea, lying flat creates an obstruction of the airway, so much so that the person stops breathing. This is noted as a pause in breathing that can last for a few seconds to longer than a minute. What the partners of sleep apnea patients typically hear is snoring that stops when the patient's airway obstructs. This is followed by a lack of breathing sounds, then a gasping of air as the patient tries to recover his or her breathing. Patients themselves don't notice this pattern.

Because sleep apnea interferes with deep sleep (stages 3 and 4), sleepiness and fatigue are the most common signs of sleep apnea. But the risks go beyond sleepiness. Chronic sleep apnea in men leads to a higher risk of hypertension and diabetes and lower testosterone levels. Over the years, sleep apnea places stress upon the heart, increasing the risk of heart attacks and strokes. Further, sleep apnea increases the risk of abnormal heart rhythms in the middle of the night, which can lead to sudden death. Considering the degree of your wife's uncle's daytime sleepiness, he may have severe sleep apnea.

I would voice these concerns to your wife's family members, and urge them to enroll him in a sleep study for a definitive diagnosis. I have many patients whom I suspect of having sleep apnea, but who are reluctant to take part in a sleep study because they don't want to sleep in a lab, even one designed for sleep. If your uncle shares that fear, tell him -- as I tell my patients -- that a sleep study can also be done in the comfort of their own home with a monitor hooked up in the house.

After diagnosis comes treatment. Sleep apnea is correctable with use of a pressure mask that keeps the airway open, called CPAP, for continuous positive airway pressure.

That's not to say CPAP is an easy cure. Many people have difficulty using this mask at night, and still others don't want to investigate the possibility of sleep apnea for fear of having to wear a mask over their face all night.

For those who have difficulty with CPAP, a device called a mandibular advancement device is also an option. This device acts like a rigid retainer to push the lower jaw forward and open up the airway.

Despite the unpleasantness of the remedies, your wife's uncle and family should be made aware that sleeping all day isn't normal and that a sleep study is vital. The health risks are too great to ignore.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

Dear Doctor: I know that Adderall is prescribed to children with ADHD. But lately I've been reading stories about college kids who use Adderall to help them study. What is Adderall and who should take it?

Dear Reader: You've hit on a topic that's timely, complex and quite often controversial. When prescribed and used properly, Adderall can be beneficial. But as with any prescription drug, off-label use can create a host of problems.

Look at first-person accounts and you'll find numerous parents of children with ADHD -- that's attention deficit hyperactivity disorder -- who detail the ways that Adderall has helped their son or daughter. But it doesn't take much digging to find that abuse of the drug is a growing problem.

Let's start with the drug itself. Adderall is the brand name of a prescription drug composed of two stimulants -- amphetamine and dextroamphetamine. It has been approved by the Food and Drug Administration to treat children, adolescents and adults who have been diagnosed with ADHD, a condition marked by a cluster of disruptive behaviors. These may include agitation, lack of focus, disorganization, forgetfulness, fidgeting, excessive talking or frequent interrupting. Adderall is not approved for use by anyone younger than 6 years old.

As with all stimulants, Adderall increases the levels of dopamine in the brain. Dopamine is a chemical known as a neurotransmitter, which plays a role in learning ability, movement, attention, and in feelings of pleasure or even euphoria. Adderall helps people with ADHD feel calm and remain focused.

The problem is that Adderall abuse among young adults is rising. According to research conducted at Johns Hopkins University, the number of prescriptions for Adderall among young adults remains steady. However, levels of abuse, as well as visits to the emergency room due to adverse effects of that abuse, has spiked.

The newest research shows that misuse of Adderall is highest among young adults between the ages of 18 and 25. Although some may obtain their own prescriptions, most are either buying the medication illegally, or are getting it from family members or friends.

Between 2009 and 2011, the time period covered by the study, use of Adderall among young adults without a prescription rose by 67 percent. During that same time period, ER visits associated with non-prescription Adderall use rose by more than 150 percent.

The drug has a reputation as a study aid that increases concentration and sharpens focus. But non-prescription use of Adderall carries serious risks. Common side effects include stomach upset, increased heart rate, dizziness, dry mouth and mood swings. Adderall is a controlled substance, and possession without a prescription is a felony.

The bottom line is that non-prescription use of Adderall for any reason is both dangerous and illegal.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

Dear Doctor: I'm a 45-year-old man without any major medical problems. Is it worth it for me to get yearly physicals with my primary care doctor?

Dear Reader: That's a difficult question to answer. I have generally encouraged annual physical exams for most of my patients in their 40s and beyond. I schedule more time for this type of examination so that I can collect a history of a patient's lifestyle, conduct a review of their symptoms, and determine whether they have had the recommended colonoscopies, mammograms and vaccinations. With both the history and the physical examination, I learn aspects of the patient's health that were often not known to me prior.

From my subjective vantage point as a primary care doctor, I find value in these visits. But objectively, the benefit of physical exams is less clear.

Take a 1986 study comparing death rates of more than 5,000 men between the ages of 35 and 54 who'd had six health checkups to more than 5,000 men who'd had one checkup. Over a 16-year period, researchers found a decrease in death rates from colon cancer and hypertension among those men who had more checkups, but they found no decrease in death rates from other causes.

A 2007 article in the Annals of Internal Medicine reviewed 33 studies assessing the efficacy of health checkups. Researchers tried to determine if physicals caused benefit, caused harm, or had no impact on a patient's health. The largest benefit seen from physicals was through an increase in colon cancer screening. A more intermediate benefit was seen through the administration of Pap smears and cholesterol checks. The physicals also showed a benefit in decreasing worry among patients.

However, overall, the results showed no benefit seen in regard to death rates. The biggest problem with this assessment is that the different studies included so many variables, reaching conclusions proved difficult.

A 2012 British Medical Journal study analyzed a combination of 14 older studies assessing the benefits of health checkups. The study did not find any difference in death rates between those who had physicals and those who didn't. However, in one case, what the authors defined as the group receiving health checkups amounted to one physical over a 22-year period. In fact, participants in eight of the 14 studies evaluated had only one physical exam done for the time frame of their studies. The studies that showed more health checkups actually had better outcomes. The authors also tried to show if having physicals actually caused harm, but could not do so.

Obviously, the question needs to be studied further -- and electronic medical records give us the ability to do this. The critics of routine health checkups say they lead to unnecessary testing, possibly harmful tests and cost about $10 billion per year.

Yet I find that the most important aspect of the health checkup is the time to sit with patients -- to talk to them about their level of exercise, their diet, their drug habits and their level of sleep; to review whether they’re having shortness of breath, chest pains, or problems with urination or bowel movements -- and many times to learn about the stressors in their lives. This time is an important aspect to the doctor-patient relationship and is difficult to quantify.

So, if you are healthy, 45 years old and not on any medications, I would recommend that you get a health checkup every two years. But, of course, put your trust in your own primary care doctor's opinion regarding this matter.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)