DR MAX: Why you should never go to bed after a row with your husband

Victor Meldrew. Basil Fawlty. Reginald Perrin. The grumpy, mentally checked-out, impossible older man is a great comic tradition. Hilarious on screen. Rather less so when you are sharing a bathroom with him.

A piece in this newspaper a few weeks ago generated an astonishing response from readers. It described what the writer called an epidemic of midlife women who are repulsed by their husbands.

Men who have stopped washing. Stopped engaging. Stopped, in any meaningful sense, trying.

The comments flooded in from women who recognised every word of it, who seemed to feel that mixture of relief and guilt that comes when someone finally names a thing you thought only you were experiencing.

But something about the responses struck me. It wasn’t just the frustration in them, though that was palpable.

Reading them as a psychiatrist, some of what these women were describing didn’t sound to me like men who simply couldn’t be bothered.

Some of it sounded like an illness that had never been identified as such. Not in every case, I want to be clear about that, but in enough cases that I think it is worth raising now. Could some of these men be unwell?

Women experience the menopause as a sharp, significant hormonal event. For men the equivalent (the andropause or male menopause) is far more gradual, a slow decline in testosterone of roughly half a per cent a year, which is why it so often goes completely unnoticed.

Yet it is estimated that up to 840,000 men in the UK potentially experience symptoms.

Those symptoms include irritability, low mood, fatigue, loss of libido and a kind of general withdrawal from the world.

The condition remains controversial and is not formally recognised, and testosterone replacement therapy, while it can make a real difference for some men, is not something to pursue without proper medical guidance.

But in my own practice I now routinely check testosterone levels in men who have had unexplained changes in their mood and behaviour.

In some of those cases, hormones turn out to be at least part of the explanation.

Depression is another possibility, and one that is all too easy to miss. It remains one of the most consistently under-diagnosed conditions in men, especially older men, in large part because it does not look the way people expect. We tend to picture depression as sadness, tears and visible suffering.

Sound as cure

Paying a low frequency tone at 40Hz (the pitch of a refrigerator hum) appears to prompt the brains of aged primates to flush out the toxic proteins linked to Alzheimer’s. Human trials are needed but this is remarkable. 

In older men, however, it far more commonly presents as irritability, withdrawal, a creeping indifference to appearance and self-care. Perhaps a little more alcohol than there used to be, or hobbies have been abandoned.

In general there’s a profound lack of motivation – a symptom termed ‘avolition’.

And then there is something else I want to raise that almost never comes up in these conversations, but I think should. TIAs, or transient ischaemic attacks, sometimes called mini-strokes, can in some cases produce changes not entirely unlike what those readers described.

A TIA is a temporary interruption to blood supply in the brain. Most people associate them with physical warning signs (sudden weakness on one side, slurred speech and disturbed vision) but they can sometimes bring about quieter shifts in personality, motivation and mood, occasionally with few obvious physical symptoms at all.

Research suggests that a meaningful proportion of TIA patients develop a kind of settled apathy in the months that follow.

When this happens, it is often because of changes to the frontal lobe, the part of the brain involved in drive, planning and how we regulate our emotions.

I worked early in my career for a professor who had spent decades treating dementia.

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He had one question he asked almost every person he assessed: when did you last brush your hair? He had noticed that, long before any decline becomes obvious, people tend to stop taking care of themselves. I was shocked by how often it would lead him to order a brain scan and there, in front of us, we’d see tiny bits of damage to the frontal lobes that explained the change in personality and would otherwise have gone undetected.

So if the man you are living with has become someone you struggle to recognise, it may be worth pausing before concluding that he has simply given up.

It is worth asking yourself these questions:

• When did it start? 

• Has he seen his GP lately?

• Has anyone checked his blood pressure, his cholesterol or thought to look at his testosterone levels?

• Does he seem to get any real pleasure from anything at all?

He may, of course, just be a man who has settled into complacency. That happens too, and is a separate conversation.

But he may also be depressed, or hormonally depleted, or quietly affected by something neurological that nobody has thought to look for.

The only way to know is to ask. It is well worth finding out if something else is going on before you give up on him entirely.

Zendaya's clash with a colleague

At last week’s Euphoria season three premiere in LA, Zendaya, 29, and Sydney Sweeney, 28, arrived separately and, it appears, spent an entire evening in the same building without crossing paths. 

Political differences are said to play a part. Sweeney is reportedly a registered Republican. Zendaya’s views appear to be quite different.

I have no idea what has actually gone on between these two women but the situation raises a question that comes up regularly in offices and homes across the country: how do you deal with someone when your views are at odds? 

The first step is to separate the person from their views. You do not have to respect what someone believes to get along with them. Focus on what you share. The key thing? Giving up on changing their mind. Deeply held beliefs rarely shift through argument. Stay sane, know when to let go.

When you go to bed may matter just as much as how long you stay there. 

A team from the University of Oulu in Finland tracked more than 3,000 middle-aged adults over a decade, monitoring their sleep patterns with wearable devices then tracked their health for the next 10 years. 

People whose bedtimes swung significantly from night to night and slept less than eight hours a night were at roughly double the risk of a serious cardiac event. Irregular wake-up times showed no such association.

Dr Max prescribes... an inspiring health podcast

One of the UK’s most popular health podcasts, hosted by a GP who has spent years making the case that how we live and how we feel are far more closely connected than mainstream medicine tends to acknowledge. 

Chatterjee talks to experts about sleep, stress and the link between physical and mental health. Practical, accessible and never preachy.