Dear Doctor: I recently read that patients of younger doctors have a lower risk of death than patients of older doctors. How could this be? Don't older doctors have more experience?

Dear Reader: I was fortunate when I started my practice in internal medicine to be surrounded by seasoned, experienced doctors. After I saw patients, the medical questions abounded in my mind. Did I make the right decision about a complicated case? Was this the correct medication for this patient's illness? What lab tests should I order? Should I do an imaging study? I brought my uncertainties to these older doctors, and they gave me sage advice in return.

The study to which you're referring was published recently in the British Medical Journal. The authors analyzed data on Medicare patients over 65 who were hospitalized between Jan. 1, 2011, and Dec. 31, 2014. The physicians caring for them were hospitalists; that is, doctors who care predominantly for hospitalized patients. The authors divided these physicians into four age groups and studied the mortality rates of their patients in the first 30 days after hospital admission. They also assessed the cost of care and whether patients were readmitted after discharge.

The youngest group of physicians had an average age of 35. The oldest group of physicians had an average age of about 64. The study included 10,177 physicians younger than 40, and 1,086 older than 65.

The authors found that physicians younger than 40 had a 30-day patient death rate of 10.8 percent; those over 65 had a 12.1 percent death rate. The greatest disparity was seen among doctors who took care of fewer than 90 patients in the hospital per year; there was no age difference in the death rate among those doctors who took care of more than 201 patients per year.

Neither the 30-days readmission rate nor the cost of care was significantly different between the older and younger doctors.

The authors mentioned that patients seen by the older and younger physicians were the same. However, the oldest group of physicians had slightly more patients with congestive heart failure, lung disease, diabetes, neurologic disorders and mental illness. If you combine the higher mortality rate for all these maladies, that small difference could explain the very slight discrepancy in the death rate seen with the oldest group of doctors.

Also, consider that hospitalist medicine is a relatively new form of practice. The older doctors in the study probably started their careers by working not only in a hospital, but also in an outpatient clinic. The younger doctors in the study may have had more specialization in hospital practice and thus better outcomes in that setting. But the older doctors with busy hospital practices have comparable death rates to the younger doctors, so that potential connection isn't clear-cut.

In any case, this study was conducted among in-hospital physicians, so the findings wouldn't apply to doctors who practice in an outpatient setting.

Overall, I wouldn't make a huge issue regarding a hospital doctor's age unless that doctor sees relatively few patients in the hospital each year. As my older colleagues taught me, experience counts.

(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. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I've always been a sound sleeper, but in the last few months, I'm tossing and turning way into the night. I really don't want to start take sleeping pills. Is there anything I can do?

Dear Reader: With our busy lives and jam-packed schedules, sleeplessness is becoming a national epidemic. The federal Centers for Disease Control and Prevention say that one in three adults doesn't get enough sleep. In fact, the CDC identifies sleeplessness, also called insomnia, as a public health problem.

The first intervention that we recommend is evaluating for medical reasons for your sudden insomnia. Sleep apnea, depression and restless leg syndrome are a few of the conditions associated with lack of sleep. However, if all is well and you've simply hit a rough patch, here are some steps you can take to give yourself a better shot at a good night's sleep:

Plan ahead: You can help your body to anticipate sleep cycles by following (and abiding by -- that can often be the challenging part) a set bedtime. Decide what time you will get up in the morning and again, follow through.

Get moving: A half-hour or so of exercise during the day can help with sleeplessness. A swim, a brisk walk, getting your heart rate up with hand weights or a game of tennis, whatever is easiest and most enjoyable will work. But don't exercise in the hours before your set bedtime as doing so can actually interfere with sleep.

Here are some more tips:

-- Limit caffeine: If you're a morning coffee drinker, keep it to one cup. After that, skip the caffeine. This includes tea, sodas, energy drinks and (sorry) chocolate.

-- Watch your alcohol and nicotine intake, which are bad for sleep: Both tend to keep you in the lighter stages of sleep, which means waking easily throughout the night. And we wouldn't be doing our jobs if we didn't urge everyone to quit smoking altogether. It's a deadly habit.

-- Make sure to relax: This is easier said than done, which is why we encourage our patients to try mind-body techniques like meditation, mindfulness, breath work, guided imagery, yoga and tai chi. The sustained flow and rhythmic breathing helps to minimize stress.

-- Limit screen time: Many of us are tethered to our phones and computers, but the blue light that screens emit can interfere with sleep. Turn off screens a few hours before bed. And avoid the temptation of sleeping with your phone by your bed.

-- Try a transitional activity: Reading a book, listening to music or doing a crossword can help ease you from daytime alertness to the softer edges of sleep.

-- Create the right environment: Do what you can to minimize light and noise in the bedroom. Earplugs and an eye mask can help. Research shows that we sleep better in cooler temperatures.

-- Try relaxation techniques: Starting at your feet and slowly moving upward, focus your attention on each region of your body. When you feel it relax, move on. If you get to your head and you're still awake, start over.

If insomnia persists, we recommend seeing your physician. He or she can offer new insight and may offer supplements or medications. If needed, your doctor can steer you to a good sleep specialist.

(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. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Can lutein really help prevent, or treat, macular degeneration?

Dear Reader: Age-related macular degeneration, or AMD, is the leading cause of irreversible blindness in the elderly. It's a progressive disease affecting the macula, the central portion of the retina involved with central vision. Changes linked to AMD generally begin after the age of 40, and estimates suggest that approximately 50 million people worldwide suffer from some form of AMD. Further, rates of people with late stages of AMD are increasing.

Research has long suggested that diets high in lutein -- an antioxidant related to beta-carotene and vitamin A -- could reduce the risk of the disease. Like its better-known cousins, lutein is one of nearly 700 organic pigments called carotenoids that absorb light energy and act as antioxidants in plants, bacteria, fungi and algae. A special characteristic of lutein -- and of another carotenoid, zeaxanthin -- is that they accumulate in the retina of the eye and help form retinal macular pigment. This pigment absorbs damaging blue and near-ultraviolet light and thus protects the macula from light injury. In addition, these carotenoids' antioxidant effects help protect the eye from various types of damage.

A typical American diet contains 1 to 2 daily milligrams of lutein. It's found in high amounts in spinach, kale, parsley and romaine lettuce. It is found in lesser amounts in pistachios, asparagus, broccoli, green beans and eggs. One interesting aspect of eggs is that the fat content of eggs allows for better absorption of both lutein and zeaxanthin. Also, cooking oils and oils in salad dressing can increase the absorption of dietary lutein and zeaxanthin.

A 2012 analysis of six studies evaluated whether diets high in lutein and zeaxanthin had any effect on macular degeneration. The participants in the studies were followed from five to 18 years. None of the studies found any impact on the early changes associated with macular degeneration. However, the four studies that assessed impact on more advanced macular degeneration showed a 26 percent reduction among people with the highest dietary intake of lutein and zeaxanthin compared to those with the lowest intake.

The evidence for supplement use is less clear. One study, known as AREDS2, assessed the impact of 10 milligrams of lutein and 2 milligrams of zeaxanthin in supplement form among 4,203 adults over the age of 50 who already had the beginning stages of macular degeneration. After five years, those who took lutein and zeaxanthin had a 10 percent reduction in the rate of advanced AMD. Note that the study didn't include those without macular degeneration.

It's clear that lutein is helpful in the diet, but in regard to the prevention of macular degeneration, there is thus far insufficient evidence that taking a lutein supplement makes a difference for most people.

If you have been diagnosed with AMD or have a genetic susceptibility to the disease, you should certainly boost your dietary intake of lutein and zeaxanthin by increasing the amount of spinach, kale, lettuce and eggs in your diet. You should also exercise regularly and, of course, not smoke.

If you already have the early stages of macular degeneration, you should not only increase your dietary intake, you should consider supplements of both lutein and zeaxanthin.

(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. Owing to the volume of mail, personal replies cannot be provided.)