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HOUSE CALL WITH DR. SANJAY GUPTA

The Consequences of Sleeplessness

Aired April 10, 2005 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Good morning, and welcome to HOUSE CALL.
We've been talking about it all week, sleep. A new survey shows half of us say we're not getting enough of it. So we're going behind the headlines to show you the sometimes deadly consequences of sleeplessness, and how you can overcome it.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Bill Ten Eyck had reached the end of the line. His heart was failing and his doctors told him, he might soon need a heart transplant. But then he learned something that would change everything. He had sleep apnea.

BILL TEN EYCK, SLEEP APNEA PATIENT: During a measurement of one hour during the night, it showed that I stopped breathing 33 times. The longest of which was a minute and the shortest of which was 15 seconds.

GUPTA: Important for tonight, because studies have shown sleep apnea can contribute to heart disease.

DR. THOMAS LURUSSO, N.VA. SLEEP DIAGNOSTIC CTR.: What actually happens during a sleep apnea event, is when the airway closes, the blood oxygen level drops. So it's really no different than me coming in and putting my hands over your neck.

GUPTA: A new survey from the National Sleep Foundation found one in four respondents were at risk for sleep apnea. And sleep apnea is just one cause of sleep deprivation. Stress can also lead to insomnia, and poor health is just one side effect from lack of sleep.

The same survey found that 78 percent of those polled said they were getting less sleep because of their partner's sleep problems. And a third said lack of sleep had a negative impact on their sex life. Most importantly, the National Sleep Foundation is warning adults against ignoring sleep problems.

DR. BARBARA PHILLIPS, NAT'L SLEEP FOUNDATION: Sleep is like anything else. It's like calories, or the amount of exercise, or our hair color. Not one size fits all, but the vast majority of people should do well with between seven and nine hours a night.

GUPTA: If this sounds easier said than done, here's tips on how to get more sleep. Try to wake up and go to sleep at the same time every day, even on weekends. Avoid caffeine after 2:00 p.m. Keep the bedroom quiet. No working in bed, no TV in bed.

As for Bill, he wears a special mask at night which helps him breathe easier.

TEN EYCK: My heart was able to perform better because it was getting rest. I think that had I not been diagnosed with sleep apnea, had I not been using this machine for the last five years, I probably would have been history.

GUPTA: And today, he's no longer in need of a heart transplant.

(END VIDEOTAPE)

GUPTA: Many people don't understand just how much of an impact sleep can have on your health. Yet, lack of sleep has been linked to diseases like diabetes, heart disease and hypertension. And a recent study showed not getting enough sleep can also increase your risk for obesity. A lot of people pay attention to that. So sleep and the lack of it doesn't just make you cranky, it could be having a serious impact on your health.

And helping us to dig into this topic even deeper is Gary Zammit, he is the founder and director of the Sleep Disorders Institute at St. Luke's Roosevelt Hospital in New York.

Welcome, first of all.

DR. GARY ZAMMIT, ST. LUKE'S ROOSEVELT HOSPITAL: Thanks for having me.

GUPTA: Yeah. Listen, this is what you do for a living. Do you think people fundamentally understand how important sleep is to their health?

ZAMMIT: Well, many of us have been unaware of how important sleep really is to our health. We haven't heard about the many types of sleep disorders that can disrupt sleep, and many of us often ignore sleep to attend to other areas of our lives -- work, relationships and recreation.

So sleep hasn't been top of mind until recently, when we've understood that sleep loss, or sleep disorders, can have significant negative impact on our lives.

GUPTA: And Dr. Zammit, we've been talking about this poll. The new polls shows 75 percent of adults have symptoms of sleep problems, and yet the same percent say they're getting enough sleep. How do you reconcile that conflict?

ZAMMIT: Well, many people have discounted their sleep problems. And, in fact we know from the National Sleep Foundation poll that many people don't consider their sleep problems significant enough to talk to a physician. In fact, if people are not getting adequate sleep or if their sleep is disturbed or fragmented, or if they're fatigued or sleepy during the day, they may be suffering from a sleep disorder that requires medical attention. GUPTA: Just a few months ago, football great Reggie White suddenly died in his sleep. He was just 43 years old. While his death is blamed on an inflammation of the lungs and heart, doctors say sleep apnea was also a factor. Both his weight and the fact that he was a man put him at higher risk for this sleep disorder. It also occurs two to three times as often in older adults. Doctor, a lot of viewers have questions about this particular topic.

And let's start with one from Paul in Virginia who asks: "Do people who have sleep apnea and use a CPAP machine ever get over this condition naturally?"

What do you say to them, doctor?

ZAMMIT: Well, sometimes. It's important to know that sleep apnea is a sleep-related breathing disorder in which breathing is compromised during sleep. There is either reduction or a complete cessation of breathing at various points during sleep.

This creates tremendous stress on the cardiovascular system and can increase risk for health problems like high blood pressure, cardiac arrhythmias, stroke and cardiovascular death.

People who are using CPAP are using a machine or a device in which they wear a nose mask over their nose. The mask is attached to a small hose that goes to a machine that sits at the side of the bed. The machine works by just taking in room air, pressurizing it, and pushing it up into that nose mask to help push the airway open and keep it wide open so that person can breathe in and out normally. So, CPAP, continuous positive airway pressure, CPAP is really a treatment for sleep apnea. It's not a cure.

The CPAP itself will not cure the disorder. However, there are some people who while using CPAP, are able to lose weight. Very often, sleep apnea is linked to obesity. If they lose substantial amounts of weight during CPAP use, they may actually improve their condition and may be able to get rid of that CPAP machine if they reach and maintain their target weight.

GUPTA: Let's keep on topic here. Barbara from Colorado, she has an e-mail. She writes: I've been diagnosed with sleep apnea and prescribed a CPAP machine. One of the ones you were just describing. I wake up at night with very dry throat, sometimes gasping for air. Are there other treatments for sleep apnea and, if so, how effective are they?"

I got to tell you, Doctor, those masks do look pretty uncomfortable. Are there other options as well?

ZAMMIT: There are. The masks do look uncomfortable, but CPAP works for about nine out of 10 people with sleep apnea. And even when people have problems, like dry mouth or a dry airway, a dry nose, we can do some things to help improve that situation, like add humidification, warm water humidification to the system, that helps to improve those adverse reactions. But, if CPAP is not the best treatment for someone, there are surgical approaches to treating sleep apnea. Weight loss is a common recommendation in treating sleep apnea. There are positional treatments, and there are even dental devices, that can be manufactured or made by a skilled dentist, that can be worn by the person with sleep apnea to improve airflow during sleep. There are lots of options.

GUPTA: We're talking to Dr. Gary Zammit. He's a sleep doctor. We have to take a break. We're going in depth to try to get you more sleep.

(COMMERCIAL BREAK)

ANNOUNCER: You want it, can't get enough of it, think about it all day long. We're talking about getting those Zs. How you can get more of it coming up on HOUSE CALL.

First, take today's "Daily Dose" quiz. Which three states do not spring forward and fall back? That answer coming up.

ANNOUNCER: Before the break we asked, which three states do not spring forward and fall back? The answer, most of Indiana, Arizona and Hawaii.

GUPTA: Well, for most of us this week has been about adjustments. More sunlight to be sure, but also the feeling that we lost an hour of sleep somewhere in the process. And this is time we can't afford to lose, with a new poll showing half of us feel tired at least one day of the week.

That tiredness can wreak havoc on our memory, alertness and reaction time. Can also make you feel less productive at work and of course, much less patient as well.

But we're going beyond the headlines this morning with sleep expert Gary Zammit. He's the director of the Sleep Disorders Institute at St. Luke's Roosevelt Hospital Center.

Let's jump right in with some questions from our audience. Rohit from Florida wants to know, "When we change our clocks, how long does a healthy body take to recover? I've seen a noticeable change in appetite and sleep."

So what do you say, doctor? Any strategies to beat the effect, and how long, as Rohit says, does it take to recover?

ZAMMIT: Most healthy people will recover from the time change within one or two days. It's interesting what happens. Our body clock, our internal clock, is linked to the 24-hour day. And when we change the time, there's an offset in that association by about an hour. And it takes one or two days to get back in sync. But people can get back in sync by setting a regular bedtime and then getting up at the appropriate time in the new daylight saving time period.

GUPTA: Another question now coming from a more frustrated viewer in Alberta. Rachel writes: "I can't figure out why I can't sleep without taking something to get to sleep. I've been this way for eight years now. I'm in bed from 8 p.m. until 4 a.m., but up about 10 times in between. I exercise and eat a mostly healthy diet. Why do I wake up so much?"

You know, doctor, so many people feel the same frustration, just not being able to stay asleep? Any advice?

ZAMMIT: Yes, this is a very common problem. Somewhere between 36 percent and 56 percent of American adults will report difficulty falling asleep or staying asleep. Getting up 10 times or waking up 10 times is not within the normal range for most sleepers.

What's going on here is interesting, because we don't know what may be being used. If you're taking alcohol to fall asleep, or perhaps an over-the-counter medication, that can have an impact. Alcohol can actually be disruptive to sleep. An over-the-counter medication may be effective in the first few days but not thereafter. So if you're waking up frequently like this, it might be important to bring this to the attention of your physician, who can offer a treatment or perhaps some further diagnostic work in a sleep lab.

GUPTA: Good, important point there. Don't drink to sleep.

Listen, doctors have a few options when it comes to treating sleep problems, from sleeping pills to behavioral therapy. Jeff in New York has a question about that first option.

"I've had insomnia for years. My doctor has prescribed Ambien, but it really doesn't seem to work anymore. Is there anything else I can try that won't lose its effectiveness?"

This is something doctors warn about, right? Becoming dependent on these sleeping meds?

ZAMMIT: Well, doctors often have warned about this kind of problem, primarily, though, in the past. Sleep specialists these days are looking at the longer term use of sleep medications, just like we use anti-hypertensive medicines for high blood pressure over the long term, it may be appropriate and safe to use sleep medications over the long term.

Sleep disorders can be a chronic condition, as in Jeff, who's going on for years with this. So a chronic treatment might be appropriate.

We know that many medications, like Ambien, do work for many people over the long term. There are new data, six-month data, on a new sleep medication called Lunesta or eszopiclone, which has recently been approved by the FDA. And that might be an alternative to a conventional therapeutic. There is ways to use the medication on a nightly or non-nightly basis that might extend one's ability to use it over the long term.

GUPTA: When you say long term, how long are you talking about? ZAMMIT: Well, the data that we have on Lunesta are six-month data showing effectiveness and safety over that period. But many people may need to use the medication over longer periods, because the insomnia actually persists. And because the insomnia persists does not necessarily mean that one has become addicted to a medication or dependent on a medication. It may simply be that one needs medicine in order to sleep and sleep well over longer periods -- a chronic condition that needs a chronic treatment.

GUPTA: OK. Everyone at home, don't go to sleep just yet. We have got more HOUSE CALL coming up.

ANNOUNCER: They claim to give us a good night sleep. Vitamins, herbs, over-the-counter sleeping pills. Do they really work?

And men and stress.

UNIDENTIFIED FEMALE: OK, Greg, I'm going to cleanse you today with an essential cleanser.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN MEDICAL CORRESPONDENT (voice-over): De- stressing takes on a new twist. But first, some of this week's medical headlines in "The Pulse."

Another arthritis drug is pulled from the market. Drugmaker Pfizer removed the painkiller Bextra at the request of the FDA. The FDA says it was the risk of serious skin reactions that caused them to make the decision. Pfizer respectfully disagrees with the agency and says they plan on exploring their options.

The FDA is asking Pfizer to put the strongest possible warning, the black box warning, on the only remaining COX 2 drug on the market, Celebrex.

A new treatment may offer hope to thousands of U.S. adults suffering from alcohol dependence. A study published in the "Journal of the American Medical Association" and paid for by the makers of the drug, shows an injectable form of the alcohol dependency drug, Naltrexone, may be the help so many are looking for.

Naltrexone is one of several pills approved for treating alcohol dependence, but it requires you to take it daily. The once-a-month injection would offer convenience for those patients who don't adhere well to taking a daily dose.

Christy Feig, CNN.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. If you're running out of sheep to count and the Sandman hasn't brought you dreams, this is the show to watch. Sleep expert Gary Zammit is here to help us get some shut-eye, but not before the show is over, right? OK.

Gary, we've touched on this during the show, but a lot of people can get some more sleep by changing their habits.

Good questions. Patty in New York may be one of those people. She writes: "Sometimes in the evening I doze off while watching TV. I wake up and I go to bed, but by the time I get there, I get a second wind and cannot fall back asleep."

Patty, I can relate to you. Doctor, what can we do?

ZAMMIT: This is not an uncommon report from people who suffer from insomnia. They may fall off to sleep in a place that's inappropriate, but when they finally get into the bed, the bed becomes their battleground.

And one of the best things to do for this is a kind of behavioral treatment in which you really stay awake and stay out of situations or positions in which you might fall asleep inappropriately, and then get into bed at the appropriate time.

And there are some behavioral techniques if that simple one doesn't work, some more aggressive behavioral techniques that sleep specialists, or your primary care doctor, can recommend to help overcome this kind of thing.

GUPTA: Patty, don't sleep on the couch anymore, OK?

Listen, dozens of products from nose strips to vitamins are sold claiming to help sleep. The question is do they work? Robert in Florida writes: "Will Melatonin help us adjust to the "spring ahead" syndrome? How safe is it? And how much should you be taking?"

Doctor?

ZAMMIT: Melatonin is a hormone which is sold over the counter and which some people have used to help them fall asleep and stay asleep. We know that Melatonin may have some use in regulating sleep rhythms, but its specific use in adjusting to the time change is not known. And it's not known to have sleep-inducing effects in people with insomnia. So the use of Melatonin cannot be across the board recommended.

GUPTA: OK, lots of good information here. Plan on taking a trip any time soon? You need to stick around so you can hit the ground running on your next vacation. Stay with us.

ANNOUNCER: Tips for battling the grogginess of jet lag coming up.

Plus.

UNIDENTIFIED MALE: I work long hours. And this is one of the things I can do for myself that I enjoy.

ANNOUNCER: De-stressing at the spa is not just for women anymore. That story just ahead.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL. Reducing stress is a good way to get better sleep. And now a stress-busting treat that women have used for years is taking a masculine turn.

(BEGIN VIDEOTAPE)

UNIDENTIFIED FEMALE: OK, Greg, I'm going to cleanse you today with an essential cleanser, and this is really good.

HOLLY FIRFER, CNN CORRESPONDENT (voice-over): This might just be the new version of the gentleman's club.

UNIDENTIFIED FEMALE: These cool compresses.

FIRFER: Facials, hot stone massage, manicures and pedicures. Surprised? You won't find any pampered women here. At this spa, it's all about taking care of men.

ANDY JONES, PRESIDENT & CEO, JOQ DAY SPA FOR MEN: From the minute you walk in the door, you know you're in a day spa for men, because you see dark woods, you don't see any floral things. Everything that we're doing is focusing on what men need.

FIRFER: And that need is growing. According to the International Spa Association, men account for nearly 30 percent of spa goers in 2003.

GREG, JOQ CLIENT: I think every now and then, you need to treat yourself to something. And I work hard to make a living and I work long hours, and this is just one of the things that I can do for myself that I enjoy. It's something strictly for me. That's why I do it.

FIRFER: Holly Firfer, CNN.

(END VIDEOTAPE)

GUPTA: That looked pretty nice, actually. Thanks, Holly. I think I'd sleep better after a massage as well.

We're talking about getting those Zs with Gary Zammit. He's founder and director of the Sleep Disorders Institute at Saint Luke's Roosevelt Hospital Center in New York.

I think we've got time for one more question. This on a very popular problem, jet lag. Malini from Florida writes: "I travel a lot between California, Miami and London. My sleep hours and days always get thrown off. Sometimes for a day and sometimes for a week! How can I deal with jet lag?"

And, Doctor, business travelers were recently polled; 25 percent of them admitted to falling asleep in meetings; 25 percent, because of lack of sleep. And 70 percent said they felt like they were less productive after traveling. So what can they do?

ZAMMIT: Jet lag is a common problem, especially for travelers who are traveling across so many time zones as Malini. What happens is that the body's internal clock becomes out of sync with the time in the traveler's time zone. Best thing to do when traveling east to west is to stay awake in your new time zone until the appropriate bedtime in that time zone. When traveling west to east, perhaps get some sleep on the plane and then again stay awake during the day, and go to sleep or go to bed at the appropriate time in the new time zone. Get plenty of exposure to bright light, and avoid using alcohol on the trip. All good tips to help a traveler get better sleep.

GUPTA: Really good tips. Thank you.

And from jet lag to drowsy driving, you can get help staying in dreamland by checking out sleepfoundation.org. That's the National Sleep Foundation Web site. Another great resource, the American Academy of Sleep Medicine at sleepeducation.com.

You can find a sleep center near you, or print out a sleep diary.

We're out of time. I want to thank our guest, Dr. Gary Zammit. Thank you so much.

ZAMMIT: Thank you.

GUPTA: And thank you, as well, at home for all of your e-mails. Make sure to watch next week when we're going to tackle the sniffles, stuffy noses and watery eyes of allergy season. Yes, it is here.

Remember, this is the place where you get to ask the experts all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned for more news on CNN.

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