Sleep Disorders

Last Editorial Review: 10/23/2003

WebMD Live Events Transcript

Are you one of the 100 million Americans that has trouble with sleep?

Virgil D. Wooten, MD, is the Director of the Sleep Disorders Center of Greater Cincinatti. With over 25 years of research and clinical experience, Dr. Wooten's work has covered the full range of sleep-related subject matter, from narcolepsy to insomnia and everything in between.

We are a nation of zombies. Approximately 100 million Americans are currently sleep deprived, costing the economy an estimated $100 billion in lost productivity through increases absenses, illness, and, in extreme cases, even death. If you are one of the 40 million Americans with one or more of the 80 known sleep disorders, then finding the right treatment can be... exhausting.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

moderator Your guest today is Virgil D. Wooten, MD... and our topic of the afternoon is sleep disorders.
Feel free to ask your questions at any time by typing /ask, followed by your query.
Thanks for joining us today, Dr. Wooten.
Dr. Wooten Thanks for having me.


moderator Well, since I'm the moderator, it is traditional that I grab the first question.... and, if you don't mind, I'd love it if you could begin by describing what it is you do. What's a typical day like for you?
Dr. Wooten I am a full time sleep specialist -- I take care of people with sleepiness, insomnia, and unusual activities during sleep.


moderator Let's put this is perspective for a second -- how many people in the U.S. have sleep disorders?
Dr. Wooten Various estimates on various disorders. Chronic insomnia affects about 10 percent, while sleep apnea affects about 7 percent.  Restless legs affects about 4 percent of the population.


abstrack_WebMD  What can I do to make my girlfriend stop snoring?
Dr. Wooten Snoring is a symptom of airway obstruction or blockage -- she will need to have this assessed to determine how serious the problem is.

Sometimes it is just nasal allergies, lack of sleep, too much alcohol...  More importantly, it needs to be determined if she has sleep apnea.

In addition to snoring loudly, apnea causes oxygen drops in the nightwhich in turn cause awakenings, increased urination, high blood pressure, morning headaches. The sleep disturbance caused by apnea causes tiredness and sleepiness. We worry the most about auto accidents due to sleepiness.

If she has nasal allergies alone, prescription nasal sprays, antihistamines and decongestants could be the solutionbut if she has other symptoms of sleep apnea, a more thorough evaluation at a sleep center might be in order.


joyhope_WebMD  How do you get diagnosed with sleep disorders? Not just 'bad sleep' from bad days?
Dr. Wooten There are various sleep disorders.

If you cannot sleep you have insomnia. If you are tired and sleepy despite adequate sleep, you may have sleep apnea, narcolepsy or other medical disorders that cause sleepiness. If you sleepwalk, wet the bed or scream out in your sleep then you have a parasomnia.

All of these various conditions are seen at sleep centers. Perhaps if you could be more specific...?


moderator What does it take for insomnia to be considered a clinical problem, in need of treatment?
Dr. Wooten If a person cannot get to sleep in less than 20 minutes, has multiple or prolonged awakenings or doesn't get enough sleep to feel rested and alert, that is insomnia. However, some people do not get enough sleep because they don't allow it --  that is not insomnia, just inadequate sleep.


smersh_WebMD There was some debate recently, in News of the Weird of all places, about a man who has supposedly been up for 40 years. Is such a thing even possible?
Dr. Wooten I have seen anecdotal reports like this, especially in off-beat publications, but the reality is that absolute insomnia is fatal.

Sometimes we see short sleepers, needing only a few hours of sleep. We also see people with very poor sleep perception some people believe that they get little or no sleep, but do not feel tired or sleepy the next day

When tested, they show normal sleep.

Studies of laboratory animals under total sleep deprivation show that they die. A rare disorder called fatal familial insomnia results as the name implies, in death of those afflicted.


belsnickle_WebMD   I have been an insomniac since I was a child. I just do not need 8 hours of sleep. But society deems the 8 hour cycle gives you the best rest. How can I increase the number of hours I sleep without simply lying in my bed with nothing to do, waiting for the world to wake up?
Dr. Wooten If you are tired, you may want to find a sleep center with an insomnia program. If you can sleep less than 8 hours and feel rested, try shortening your bedtime to the amount you need.

abstrack_WebMD  Do you lend much credence to the idea of "sleep debt"?
Dr. Wooten Depends on the definition. If we do not get enough sleep, we get progressively more sleep over several days. We must oversleep at some point to bring us back to equilibrium. But chronically undersleeping for a year doesn't mean that we have to oversleep for the exact amount of time we under slept. The brain is nice enough to recover on just a few nights of recovery sleep


moderator So, you can't put sleep in the bank to be used later?
Dr. Wooten I wish.

We cannot sleep more than we need indefinitely, either. Insomniacs find this out the hard way -- they spend more and more time in bed trying to catch up or capture more sleep.

Unfortunately, it works against them. They become frustrated because they are just spending more time in bed not sleeping. The one situation in which trying to "store up" sleep is helpful is in the case of heading into a jetlag or shift-work situation. By getting a couple of good nights of sleep before traveling to a new time zone or going on a graveyard shift, a person can feel better and perform better on the new schedule.


moderator that actually bring up this next question....
smersh_WebMD  What kind of advice do you give to workers who work odd hours?
Dr. Wooten I wish it were practical to tell them to get a day job.

Unfortunately, 25 percent of the workforce does shiftwork, and that may get worse. It is a tough area to give generic advice for, because there are so many different shift schedules. If a person works a graveyard shift, they should try the following:

  • Dont drink caffeine within 4 hours of going to bed
  • Allow a couple of hours to unwind before going to bed
  • Darken the bedroom completely
  • Wear eyemasks, earplugs and use sound generators to help sleep in the day
  • Avoid exposure to daylight or exercise in the morning before going to bed
  • Try to sleep part of the time in the mid afternoon to take advantage of a biological tendency to sleep at that time of day
  • Don't answer the phone, the doorbell or run errands during you scheduled bedtime, after all you wouldn't do it if you were trying to sleep at night
  • Set a schedule to go to bed and get up. Stick with it , even on your days off if possible.


bill31_WebMD  I only get about 5 hours of sleep a night and it is not usually continuous. Is there a good non-prescription medication that may help?
Dr. Wooten There are no good non prescription medications. Most of the over the counter stuff is weak, short lived, or has more side effects than I like to see. For insomnia, I recommend learning relaxation techniques, good sleep habits, and as a last resort, prescription sedatives.

The prescription sedatives are only to be used when physical sleep disorders have been assessed by history or sleep testing.  Some people need chronic sedatives and it is ok, in my opinion if all else has failed. However, I have found that some people do better with behavioral techniques and medications specific to their CAUSE of insomnia.

For example, if a person has restless legs syndrome, there are several effective medicines. If a person is obsessive/perfectionistic/Type A, selective serotonin reuptake inhibitor might be better to reduce their underlying tendency to think and worry too much.

Of course, if the person has full blown anxiety or panic attacks the drugs I just mentioned can help. And, if depression is present these drugs and other types of antidepressants should be used.


joyhope_WebMD  Does a sleep pattern, like sleeping in the day time and work in night hours, affect the brain functioning in other ways?
Dr. Wooten Typically, shiftworkers don't sleep as much or as well during the day as do night sleepers. The symptoms of inadequate sleep are memory impairment, inability to process complex information, reduced reaction time, irritability and moodiness. As far as any permanent impairment there is no firm supporting evidence for that.


abstrack_WebMD  Are persistent nightmares considered a sleep disorder?
Dr. Wooten Yes. I usually see that in people who have been abused or traumatic situations (like combat, rape, etc). Also in people who grew up in families with a lot parental fighting...

As far as treatment, most of the time that is best addressed through psychotherapy and medications, not by most sleep centers. There are some specific techniques applied to recurrent nightmares that specially trained psychologists use. The one situation in which a sleep center might help is in REM sleep behavior disorder. This is a situation in which an individual can actually act out their dreams. It can cause injury to self and others.


moderator Well, Sir... I just wanted to thank you for coming by today to do this. Do you have any closing thoughts?

Dr. Wooten Thank you very much. This has been very enjoyable, and I hope that it has been useful for you and your participants.


moderator It certainly has been a pleasure having you by... and thanks everyone for your great questions.
Your guest today has been Virgil D. Wooten, MD.

Dr. Wooten Thanks, you did a great job. Signing off.

moderator Have yourself a good Holiday season!

Dr. Wooten You too.

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