Hear a Patient Power interview with Dr. David Claman director of the UCSF Sleep Disorders Center in San Francisco.
Lack of sleep can have a major impact on your health. Believe it or not, around 40 million Americans suffer from some type of sleep disorder. Hear how to battle sleep deprivation and win. It's all next on Patient Power.
Hello and welcome to Patient Power sponsored by UCSF Medical Center. I'm Andrew Schorr.
As I said, 40 million people in America may suffer from some type of sleep disorder. Now, it may be short term. You just have a few nights, you're stressed out and you just can't sleep. I know I had altitude sickness one time, and I was like a zombie walking around. I couldn't sleep. Everybody else in my family was asleep. It was unnerving.
And then other people have something continuing, or they think they go to sleep and they wake up every day and they are tired. Well, we'll talk about all that with a leading expert. He is Dr. David Claman, who is the director of the UCSF Sleep Disorders Center in San Francisco. Dr. Claman, welcome to Patient Power.
Thank you, Andrew. Nice to be here.
Sir, I've read that maybe a third of the population experiences a sleep problem some time. It's really quite common, isn't it?
It's surprisingly common, and I think over the last 10 to 15 years there's been a lot more awareness both from physicians and the public about how common the whole range of sleep disorders really is across the population.
Now, we have to take it seriously. I mean, if you don't have a good night's sleep a time or two, maybe that's not such a big deal, but there are people who are sleep deprived, and my understanding is that can lead to real risks. For instance, it's not only you're not thinking clearly but if you're driving or operating machinery you just make mistakes when you're tired. Am I right?
That's absolutely true that there's both public safety issues related to driving and industrial activity, but also there's a big quality of life component that if you either have poor quality sleep or if you have insufficient hours of sleep that you will be tired and irritable the next day, and it's hard to get tasks accomplished, get your work done, and be able to enjoy it.
Now, one of the most common sleep problems I understand is sleep apnea, where you're having breathing problems, I guess, during sleep. Hasn't it been shown that that can cause some long term, serious health problems?
Absolutely. I often talk to my patients about obstructive sleep apnea because when the airway closes off, which occurs when your muscles relax while you're asleep, then your mind has to interrupt the sleeping, there's constant interruptions, and that's often accompanied by brief episodes where your oxygen levels get reduced. And there's a lot of good evidence that one group of patients with untreated sleep apnea will end up being sleepy in the daytime as an obvious quality of life symptom, but there's also been good research in a number of different studies showing that untreated sleep apnea puts you more at risk for high blood pressure and strokes and heart failure, these are really important concerns for us. And that's why we want people to come in and be evaluated if their doctors or families are concerned that they may have a sleep apnea.
All right. Let's go over some of this. I like coffee, and I found that I can't drink coffee after about 5:00 p.m. because I won't get a good night's sleep. I can make a behavioral change to help the quality of my sleep. That's pretty easy. But some people find that they're waking up a lot, or their partner says they're snoring. Tell us more about those sorts of things. And also, I'm not really clear, restless leg, I know is not an uncommon sleep problem. Does that mean your legs are moving around at night? Help us understand and differentiate some of these problems. You mentioned obstructive sleep apnea, and I mentioned restless leg. What are these?
Well, I guess to move into a slightly different area, we could comment on insomnia. And insomnia is when you're in bed wanting to be asleep but you're awake, and that can either happen at the beginning of the night, during the middle of the night or at the end of the night. And so insomnia has many causes. You've just highlighted two of them, actually. One would be drinking caffeine too close to bedtime. Since caffeine often stays in our system six to eight hours, depending on your sensitivity, you're absolutely right that if you have coffee or sodas after the middle of the afternoon those can cause you to stay awake and have sleep onset insomnia.
And restless leg syndrome is another cause of sleep onset insomnia typically, and in that particular condition people will have a restless sensation in their legs that makes it very hard to lie still in bed, and that restless sensation in their legs tends to keep them awake sometimes for an hour or two before they finally fall asleep. And so those are different aspects or potential causes of insomnia. But we often focus on insomnia problems in our sleep center.
Mm hmm. Okay. And then sleep apnea, that's breathing problems during the night?
That's exactly right. The most common form of sleep apnea is the obstructive type of sleep apnea, which in adults is often but not always associated with being overweight or obese, and in kids it can be an issue in kids who have enlarged tonsils. And so obstructive sleep apnea can happen in different age groups and have potential different causes.
Hmm. All right. The first thing our listeners might say is, well, what can I do myself? Some people have heard that you can take melatonin, and that can help you sleep, and be sleepy. There certainly are in the U.S. sleep aids that are advertised. How do you feel about all this, somebody just doing that on their own?
Well, let me backtrack just a sec to obstructive sleep apnea. I think that if you're a loud snorer then there is risk that you could have obstructive sleep apnea because most patients with obstructive sleep apnea are snorers. And the simple things to do at home for obstructive sleep apnea are to lose weight if you're heavy, to try to sleep on your side as much as possible because often patients on their back have a lot more apnea and a lot louder snoring, and if they can learn to sleep on their left or right sides that minimizing those issues. And also having alcohol later in the evening near bedtime can worsen snoring and sleep apnea. For sleep apnea those are the three conservative treatments.
And if you have a sleep study it may result in the recommendation of the CPAP treatment with the mask and the air pressure because it has the highest success rated of improving the symptoms. But there's a range of treatment options. And, Andrew, I think what you're bringing up, I guess, when you relate melatonin or the other prescription sleep aids for insomnia is there's a different range of potential causes, and there are medications that can be used. But typically for insomnia the first thing we try and do is change people's personal behaviors related to sleeping to see if behavioral treatment rather than medication will help them to learn to sleep better.
All right. Well, let's just go over that. One is of course, if you're a coffee drinker maybe not drinking coffee late in the day. If you're stressed I would imagine it would be some sort of relaxation.
Now, restless leg we called out as a problem that I know affects a lot of people. I know there are medications for that, so that might be discussed. But what about these sleep medicines? I've read that maybe it's not such a good idea to be taking that long term.
Well, most people would say that any medicine, if you can find a solution to a problem that doesn't involve long term medication, that's better, whether it's insomnia or cholesterol issues or eating differently for diabetes. I think insomnia has a lot in common with some of those other problems.
But it's often the case that if you take medications regularly for insomnia they become sometimes, not always, less effective over time, and so it's a lot better to focus on behavioral changes so that you can either avoid the medicines altogether or make the medications stay effective for a longer period of time.
Let's talk about what you mentioned earlier, sleep study. I think I've seen a video of this where someone actually spends the night at your center and you have a camera on them and various monitors going. What is that able to tell you so that you can help somebody sleep better?
Well, the formal sleep study is called a polysomnogram, and in the polysomnogram we're monitoring the brain wave sleep patterns, and that allows us to know when people are in dreaming or in non-dreaming sleep and allows us to quantify if they're having sleep apnea events, how often do they occur, and that allows us to say that the sleep apnea is mild, moderate or severe. And that helps us determine the best treatment options for an individual person.
And the sleep study also lets us know whether sleep is being interrupted and how low the oxygen levels go. And sleep studies can also be used not only to diagnose sleep apnea but also to look at leg kicking episodes that can be seen in patients with restless legs and also can be used to look for patients who have narcolepsy, which is a more rare cause of really severe daytime sleepiness. There's a range of disorders where the polysomnogram is quite helpful.
Now, I know some people who are diagnosed with sleep apnea you would recommend a CPAP machine — what is that, it's a positive air pressure machine, right?
Exactly. The acronym CPAP stands for Continuous Positive Airway Pressure, and it's a small air compressor that sits next to the bed and blows air pressure through a type of mask or nasal pillows, and that puts pressure in the windpipe. The analogy I like to use for obstructive sleep apnea is that every time your airway closes it's like a flat tire and you have to stop and fix it, and if you have air pressure in the tire from the CPAP air pressure then you get to keep breathing regularly and have a nice, peaceful trip through the night with restful sleep. And I find that a useful analogy to how the CPAP air pressure works.
Dr. Claman, I know you've come a long way with the equipment that's used, I imagine it's a lot more comfortable now to wear a device like this than it used to be.
I think it is more comfortable because the older style masks were stiffer and not quite as easy to wear. In truth I think CPAP is still, for some people, a cumbersome treatment, but nonetheless the different styles of masks and nasal pillows, the water, humidifier that makes the air less dry, and some of the pressure comfort settings that are available, CPAP has definitely made good progress over the last decade.
I mentioned at the outset we were going to tell people how they could really win over sleep deprivation, fatigue, or maybe your partner elbowing you all the time telling you to turn over because you were snoring, or you just feeling fatigued during the day. Do you feel now you have the tools, the behavioral tools, the medications, the devices like you just mentioned so that most people can be helped?
I think that's a challenging question. I think that the number one tool that I stress with many of my patients is to realize how important sleep is. And I think most patients who make the effort to come to the clinic have already said, you know, my sleep is important. I need to improve it somehow. But I think a lot of people say, oh, sleep deprivation won't hurt me. I'll just sleep four or five hours some nights and I'll be fine, and they underestimate how big an impact sleep deprivation can have, so they don't make a priority of this.
I think that two of the biggest things in terms of having good quality sleep actually tend to be caffeine and alcohol because caffeine, as you already mentioned, can cause you to have insomnia if you drink it at the wrong time, and alcohol in moderation is certainly common for many people, but alcohol can worsen sleep apnea. It can actually contribute to insomnia because when it wears off in the middle of the night alcohol can actually cause you to wake up and have insomnia.
And there's a lot of kind of good lifestyle issues that can be very beneficial to sleep, but not everyone wants to pay attention to those priorities.
Right. Right. I would recommend it, having seen people be helped that way. I was just going to mention one other thing that I'd love for you to talk about. Around San Francisco where you are is a pretty high technology area for a lot of people, and they have so many electronic devices now in their bedroom. How do you think a bedroom should be to promote sleep? Should it have all the TV and the gizmos around, or do you have a different view?
Well, it's an interesting question, Andrew, because I think one theme I would emphasize that was publicized a few years ago in the sleep community is that if you go back a hundred years before houses had electricity the average U.S. citizen probably slept close to nine hours a night on average, and now that everybody has electronics, and on average the population sleeps probably less an hour less per night. And, there's no way that humanity has evolved that quickly so there's a big impact of electronics in general.
And I think that generally — whether it's a computer, TV or a cell phone the closer you use it to bedtime the more it tends to keep you awake and keep you going. If you are a good sleeper and you don't have sleep issues, then maybe it doesn't make as big a difference. But if the electronics interfere with you getting to sleep or staying asleep, then they're definitely going to be a contributing factor, and then I do recommend that they are out of the bedroom as much as possible.
Okay. Well, I think for our listeners, you're all over the map, folks. Some people have trouble sleeping, some people snore, some people have real issues like sleep apnea or restless leg. If you are having problems that go on at some point you might invest in seeing a specialist such as Dr. Claman, talking to your doctor about it, doing what you can at home, because you deserve a good night's sleep.
And one last thing, Doctor, there are a lot of advertisements on radio and TV about mattresses. Do you ever just tell people, Oh, you need a more comfortable mattress?
Sometimes I think that's important. I think that if your mattress is really uncomfortable then it obviously could affect your sleeping. It just needs to be comfortable so that you're relaxed and you can stay asleep, but hopefully that's not an issue for very many people.
Dr. David Claman, director of the UCSF Sleep Disorders Center, thank you so much for being with us. I believe, hearing you speak, that people can look at their individual situation. If it really bugs them enough or if a spouse or a partner is really worried about them, then there's certainly help available, and there are some things they can try at home. Wouldn't you agree?
Absolutely Andrew. It's great to talk about these things because I think sleep disorders are common and they're important, and certainly that's why our program is here to help people.
Okay. Thank you so much for your devotion to helping people get a good night's sleep and have zest for the day and a safe day as well.
I'm Andrew Schorr. Thank you for joining us. And remember, knowledge can be the best medicine of all.
Reviewed by health care specialists at UCSF Medical Center.
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.
Sleep Disorders Center
2330 Post St., Suite 420
San Francisco, CA 94115
Phone: (415) 885-7886
Fax: (415) 885-3650
Snoring and Sleep Apnea Surgery
2380 Sutter St., Third Floor
San Francisco, CA 94115
Phone: (415) 353–2757
Fax: (415) 353–2603