"The Heart of the Matter"

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Transcripts: 536-1 and 536-2

Week: 536.1 Guest: Dr. Thomas Roth, Henry Ford Sleep Disorders & Research Center, Detroit Topic: Sleep: Dreaming, Melatonin and Sleep Apnea- Part Two Producer/Host: Steve Girard

NEMA: We're with Dr. Thomas Roth, head of the Henry Ford Health System's Sleep Disorders and Research Center in Detroit. In our last program, Dr.Roth told us that sleep is broken down into REM and non-REM sleep, which are as different from each other as they are from the waking state, and each have distinct functions....Dr. Roth which is the stage or type of sleep when we dream?

ROTH: Once again, people have this idea that your brain turns off when you go to Sleep...you know, if I wake you up in the middle of the night, you have mental activity all night long...your brain keeps going, you keep thinking, you keep plotting. When we go into REM sleep, we have rapid eye movement. We are more dreamlike, our thoughts are more sensory. Cause in non-REM sleep I'm thinking about an exam tomorrow...I'm thinking about this, I'm thinking about that. In REM sleep, you actually see things and hear things...mostly see things. So, if I woke you up out of REM sleep, you'd say, "I saw this, I saw that, I heard this, I heard that". If I woke you up out of non-REM sleep, you'd say, "I thought about this, I thought about that, so mental activity goes on 24 hours a day. In REM sleep what happens is we dream.... i.e. we tend to see things and hear things.

NEMA: There's a lot of research going on that is trying to link certain stages of sleep and how we produce certain substances like human growth hormone...and how the stages affect how we feel and regenerate....

ROTH: We have to be very, very careful about things which correlate with each other and the functions... growth hormone, which is very important in children, gets released mostly in stage three, four sleep. If I don't let you sleep for several days, your growth hormone starts coming into waking. So, very clearly, stage three, four sleep is very important in normal people in terms of releasing human growth hormone. That doesn't mean that's the function of sleep. That just sort of is when the body, under ideal circumstances, releases its growth hormone. Cortisol gets released early in the morning... virtually all your body functions follow this nice 24 hour rhythm, and sleep is a part of that.

NEMA: And what about Melatonin....many are touting it as a sleep aid...

ROTH: Melatonin is a very important secretion of the body...there's no data today that suggests, there's not very good systematic data to suggest this is a very good drug to help you sleep today. There's a tremendous amount of research, and I don't doubt in a couple years we'll have Melatonin analogs which will have clinical value. Right now, we don't know how much of this you should take, what you should take...if you're taking it at a health food store, the amounts that you're taking haven't been determined scientifically, so I think Melatonin is not indicated therapeutically today...although I think its very important, in terms of understanding sleep/wake function.

NEMA: Another problem area....sleep apnea.....what is it and how is it treated?

ROTH: It affects about three percent of Americans, who stop breathing when they sleep....due to collapses of airways, and they snore and are sleepy. It's not easily handled, but I mean sleep apnea's a disease where its more common in men than women. Its mostly in middle age, mostly in overweight men....and they tend to have hypertension. And these individuals, when they fall asleep, they block their airways, they stop breathing and they rouse from sleep... and the two things that bring them in the doctor's office are: one, they snore very loudly... and two, they're very sleepy during the day because their sleep is fragmented. Today, we can diagnose sleep apnea, we can treat it with a series of medical devices, and in some patients, surgery.

NEMA: Dr. Roth will come back in our next program to talk about insomnia, what causes it, and some potential remedies... as well as problems facing shift workers, and the use of sedatives. I'm Steve Girard.


Week: 536.2 Guest: Dr. Thomas Roth, Henry Ford Sleep Disorders & Research Center, Detroit Topic: Sleep: Insomnia and Its Remedies- Part Three Producer/Host: Steve Girard

NEMA: We're visiting with Dr. Thomas Roth, head of the Henry Ford Sleep Disorders and Research Center in Detroit.... what are some of the leading reasons you find people are hit with insomnia?

ROTH: Insomnia can be caused by one of six things: The first one is very simple, a change in the timing, the circadian rhythm thing. Very clearly, if I flew you to Japan tomorrow, then asked you to go to sleep at 11 o'clock in the morning, you'd have great difficulty. That's best exemplified by shift work and jet lag. The second cause of insomnia is medical diseases. People who have arthritis, people who have lung diseases...many normal reflexes don't work very well in sleep, so we have to arouse to correct things. Psychiatric diseases can cause insomnia...about 90% of people with depression have difficulty sleeping. That's the third cause of insomnia. A fourth cause is primary sleep disorders. Very clearly, things like nocturnal myoconis...restless leg syndrome, these are diseases... you're perfectly healthy while awake...the other three weren't, but when you go to sleep you have these primary sleep disorders. The fifth thing is drugs and medication....very clearly, a variety of compounds can cause you to have sleep difficulties...people are very seduced to drink alcohol to help them sleep, but really alcohol is a contributor to disturbed sleep. Many people are very sensitive to caffeine, and that can disturb sleep. Respiratory stimulants and things like that may cause insomnia. And finally, and this is what we're going to work on, is bad sleep habits. People will sort of ruminate about sleeping...people will go to irregular sleep/wake schedules, so these kinds of behavioral issues is the sixth thing.

NEMA: Where do you start solving the problem of insomnia?

ROTH: Best thing you do is look at the obvious...do you go to bed at the same time? Do you get up at the same time every morning? Are you avoiding alcohol? Are you avoiding caffeine? Are you napping during the day? Make sure you're spending a reasonable amount of time in bed...are you spending too much time in bed? Once you've taken care of all of those things, you call your family doctor.

NEMA: How does the change in sleep schedule affect those people who are shift workers?

ROTH: There's a 24 hour clock which keeps our body functioning. Now the main cue to our brain as to what time of day it is, is light. When you go on shift work, there's a difference between what you're doing and what the light pulses are, and therefore your body is confused...and you have difficulty staying awake...during the night, when you're working...have difficulty sleeping during the day. You also have G.I. kinds of problems, people have stomach problems.

NEMA: What do you recommend for these people?

ROTH: One, you have to realize that if you wake up after three hours, which is going to happen, you just can't get up out of bed and run around...you have to be more careful about your sleep environment, you have to make sure your bedroom is quiet...make sure your bedroom is dark. If you're rotating once a week, there's not much you can do about it, you're just doomed. It takes about four or five days for your body to adjust, and during that time, you have to do the best you can, making sure you avoid alcohol and caffeine, because those just make it much, much worse.

NEMA: What about prescribed and over the counter sleep medications?

ROTH: If you're going to fly to another time zone, you're gonna have jet lag, and you have a business meeting, its better to have a good night's sleep with a medication for the one or two nights, and have a productive time. So, I think sleeping medications, for short periods of time, are very effective, but again, its very much like a pain killer...if you have pain, it's good to get rid of it for one or two days, but if it lasts for long periods of time, you have to find out why it's there. You have to treat the underlying cause.

NEMA: Our thanks to Dr. Thomas Roth, head of the Henry Ford Health System Sleep Disorders and Research Center in Detroit. I'm Steve Girard.

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