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>> Well hello and welcome to HealthLine.

I'm Jennifer Bloomquist.

I have the privilege of hosting this program which we are doing live in our studio right now.

It's a wonderful show.

If you're a new viewer you will definitely learn something and if you're returning your you know the drill we keep the phone lines open.

That's why there's a phone number listed at the bottom of the screen since we are live and we have a live guest with us to answer any of your questions, we encourage any calls about the topic.

And tonight we're talking about sleep medicine and talking about disorders and advances in technology to try and treat these disorders also all sorts of really interesting things and I'm sure at least some of you out there have had some sleepless nights or sleep issues or know somebody who has so feel free to call anything along the topic of sleep medicine is more than welcomed.

I want to remind you you have two options if you're going to ask a question.

My favorite way to do it is you call in and that way you can talk to our doctor who's our guest here and he may have some questions for you that would help him to better answer your questions.

So if if you're brave enough and really it's fine we don't just throw you on the air.

They take good care of you on the phone lines.

Call and ask your question.

You can interact with the doctor live or if you really don't want to do that, that's perfectly fine.

Just talk to the call screener and she will take your question and then I can ask it for you.

So let's go ahead and meet our guest tonight.

He's been here a couple of times before.

I've never had the privilege of working out a program with him.

Mark Evans did but it's been a few years.

It's Dr. Rhomberg AMA and you are a sleep medicine specialist.

>> You certainly appreciate you coming back.

Yeah, thank as I said at the top of the show, I think people probably know some of the basic sleep disorders and maybe they've even had issues with them and I don't know if you want to kind of go through some of the primary ones sleep apnea, narcolepsy, sleep apnea I see all kinds of commercials and things now because that requires using that machine.

>> So I hear a lot about that.

How do you know if you have sleep apnea?

Yeah, so people have symptoms like they are snoring very loud and when they are sleeping they are waking up so many times they make a big headache in the night they have to go many times to bathroom and when they come back then sometimes they have difficulty falling asleep again and they are not feeling rested during the day.

They are feeling sleepy during the day and they are not having a lot of health conditions like high blood pressure, diabetes, migraine depression, anxiety and a lot of like no hearty suits.

>> All right.

So if you're having anything like that probably should go yeah.

Maybe start with your family doctor and see if they think it warrants a visit with a specialist.

>> Yeah, another one I think a lot of people have heard of his narcolepsy.

Yeah.

So narcolepsy like neurological illness so in that the brain keep waking up so many times during the night even though oxygen is running good but for them hundred sleepy studies so we see a lot of like arousals coming up so the quality of sleep is not good and they feel very sleepy during the day and sometimes when they are laughing they are excited.

They lose one of the muscles and sometimes they buckle down so yeah and sometimes they get a sleep paralysis and sometimes like they get hallucinations also when they wake up are going into sleep so and that can be very, very scary, very debilitating.

>> I don't even know if they would allow someone with narcolepsy to drive.

>> I don't think you're so so proper with proper treatment they are able to drive you are able to function like you know their work sometimes they need some accommodation like you know, taking a nap like no sort nap during the hour.

>> Otherwise they're like there are some newer medications and a lot of and now it is so they they get better they are not completely like no normal but they they get better to the extent that they can function like no just like other people .

>> Good to know.

Yeah.

We're going to be talking about some of the treatments for these coming up we want to highlight some of the main ones another one I'm sure everybody a lot of people joke about this one insomnia.

>> Yeah.

So yeah but it's no joke really.

>> Yeah it is no joke like a lot of people are suffering from their things and they have difficulty falling asleep.

They take more than half hour to fall asleep.

They keep waking up at least three three times in the night or more than three nights per week and at least like three months.

>> So we call it chronic insomnia sometimes some Pemulwuy events happen or something happened that is called acute insomnia.

>> So and a lot of people who have sleep apnea, they also present like insomnia.

So they are waking up because of low oxygen and brain is waking up and they think like they have insomnia but maybe they might be having underlying sleep apnea to presenting like that.

>> So yeah.

Yeah, definitely warrants getting it checked out another one I know if you want to talk about hypersomnia I had not heard of that.

>> Yeah so hypersomnia idiot broad like no definition like excessive sleepiness so someone could be having narcolepsy someone could be having idiopathic hypersomnia when you don't know the cause of it and someone having underlying sleep apnea so so that can also present like hypersomnia.

>> So in this condition people are very sleepy during the day when they are driving they are falling asleep when they are like you know doing work sometimes they are falling asleep and if they are working with machinery it is very dangerous for them.

>> Well, you've kind of alluded to it a little bit but there are definitely as you mentioned, some advances to treat all of these issues because I know when I was growing up it was just kind of like you count sheep or you know, watch TV or something something you know or people used to get those noise machines like a white noise or a fan.

>> But things have come a long way since then.

So what would you say as sleep apnea?

Would you say it's probably the most common yeah.

>> Sleep apnea is the most common issue and insomnia is also most commonly so in that sense and they both are not mutually exclusive.

Like if you like someone having sleep apnea, they can pretend like insomnia and insomnia can present sleep apnea.

So so one by one so far the sleep apnea so in the past we had only one option sleep by machine.

Yeah, but now it is there are a lot of advancement in machine also and mask also so they are more comfortable now and like there are settings we can adjust and make it better and there are some newer options like inspire therapy so that if you like a pacemaker so your small device getting implanted under the skin and it keep giving signal to a tongue to move forward with every breath.

>> So so that is a very good device and those people who have difficulty with CPR, they can get benefit from it.

They have certain like no criteria to meet but they do better on that too.

>> So and what kind of test like if somebody thinks they have sleep apnea or if you're just trying to figure out what you know what the diagnosis is, how do you do you have to monitor people and sleep?

>> Yeah.

So we monitor gold standard is to do sleep study into the sleep lab but now it is a lot of insurence required to do home sleep study first and we have came a long, long way now it is home test is also sophisticated so we can do home test time so and with that we get information whether someone is having sleep apnea or not.

A home test could be false negative intenta maybe 20 percent of cases.

So in that case be repeat like no test and possibly in lab test.

>> So I was going to say I would think people in general would feel more comfortable doing the home.

>> I would I yeah they do they do.

So maybe is I give you maybe a more accurate yeah.

So they are sleeping in their home environment they are like you know they are familiar and they do their activities they can sleep on their sleep timing not like no not the sleep that I mean so so if someone is sleeping late and waking up late they have flexibility so so that is good in that sense.

>> All right.

Let's touch on some of the other disorders insomnia again.

>> Is that something you can diagnose by monitoring sleep?

Yeah.

So insomnia can really be asked questions so it is like no clinical history but we also do sleep study to find out if they are having underlying other sleep disorders underlying other sleep disorders could be sleep apnea that is most common but sometimes people have periodically movement disorder so they are moving their legs a lot and because of that they are keep waking or they are having some other medical issues that can also lead to insomnia sometimes they are having very like you know, too much pain like going on so so they keep waking up because of that there are some other environmental issues like they are not feeling safe or like not.

There are some sounds going on so so they they keep making it because of that or having caregiver responsibilities so a lot of things can cause insomnia.

>> I was going to say you know, as a parent I just know once I became a parent I just felt like I couldn't turn it off, you know what I mean?

And you just you have that worry factor and even now my children are older but I still at night people wake up at the drop of a pin.

>> I think a lot of parents are that way.

Yeah, I have the same age so it's not really a disorder disorder.

>> It is just like you are a parent and you are taking care of your kid.

Yeah.

All right.

My husband doesn't have that issue.

He just sleeps away while I do all the worry.

>> Yes sir.

Now narcolepsy is that something that would be genetic or hereditary?

I mean could you just be predisposition to having that?

>> Yeah, so so yeah.

So it's like you know, there are some genetic factor also that predisposed to narcolepsy.

There are certain genes you didn't do so those people are more prone to have narcolepsy.

Not every person with that gene present like narcolepsy but if like no certainty is going to happen sometime viral infection or anything triggers then they they like know have to dance to to go like you know to present like narcolepsy.

>> So I like you know, reported a case that that like you know he had a genetic predisposition and after he got some infection while infection or sometimes vaccination and then he narcolepsy OK, it's interesting.

>> Yes he's doing good on undertreatment.

So I was wondering I mean do any of these issues that we're talking about happen to children?

I mean because some children just don't sleep.

I mean when they're babies, you know that first year of life the you know, the sleep can be pretty erratic.

Yeah.

Usually they get to be toddlers.

It's a little more stable.

But have you ever had to die?

Would it be even something you would look at for like a younger child?

>> Yes, a younger child.

Uh, currently I'm doing adult patients but like you know.

>> Yes, like no child can also present that with but be sent to pediatric sleep medicine for that so OK. >> Yeah.

All right.

And I just wanted to touch on we have somebody who wants me to ask you a question but we'll just quickly cover hypersomnia .

>> Yeah.

So is that just like an extreme case of insomnia?

So hypersomnia is sort of opposite of insomnia anyway like you know people feel more sleepy and and when like you know, they like to do certain activities like no drive or or work or something that they feel very sleepy so that we call hypersomnia but we have to find out what is underlying cause behind it.

Is it untreated sleep apnea or untreated insomnia that can like if they are not sleeping during the night and waking up they can pretend like hypersomnia during the day or narcolepsy or sometime idiopathic hypersomnia or they are having underlying leg movement disorder so so all these things can present symptoms hypersomnia so we have to look underlying cause and there are medications we can like no after treating the underlying cause if they are still sleeping then we can put on some medication and that helps them and reference for all of these issues.

There are there are medications we did get a call from a gentleman named John.

He wanted me to ask you if there were any non habit forming sleep medications because I think that's a big concern for people too.

They don't want to be dependent on it and I completely sympathize with that.

>> Yeah.

Are there different options or even like I don't know nabb things that are more natural like herbal or yeah.

>> So so there are like you know some non habit-forming like melatonin is natural hormone and there are someptheyd if like no you stop them like you know people are okay to stop them but there are like a lot of medication for insomnia.

They could be habit forming and I would recommend to talk to your doctor and based on like no different medicaion we can advise you how to come from that or which one is optimal medication for you when you mention the melatonin I mean you can see twenty different brands at the store.

I would just yeah I would just if you want to reiterate the importance of just maybe not just going out there and getting it because that's not a lot of those things are not regulated but yeah they are not regulated by FDA so like no they could be like no different in different formulation.

Yeah.

So I would suggest to talk to like know your doctor and see like know which one is better whether you need that or you don't need that or you need further assessment of underlying sleep disorder that might be causing you this problem and if you fix that maybe in and get better so all right.

>> So a good night's sleep is is invaluable.

Yeah I want to thank John was the name of the man who think your question and thank you so much for that, John.

And I just want to remind all of you watching that's why we keep that phone number at the bottom of the screen so you can ask a question if you would like.

You can do it the way John did or I just ask the question for him or Dr. Vermes.

Very nice person.

He'd be more than happy to talk to you like if you would like to ask the question alive.

So feel free to give us a holler any time.

In the meantime, we're going to continue to talk about sleep medicine.

One thing you had touched on in the notes you sent to me was something called Inspire Therapy.

>> Yeah.

And I don't know if you want to elaborate on what that is.

Yeah.

So inspired therapy is not restimulation trippy for obstructive sleep apnea so that is like a pacemaker for sleep apnea.

So when people have difficulty bulleting c pap machine or bipap machine then B B if they are needed for an inspired therapy then like I refer them for inspired therapy so that giving signal to the tongue to move forward in the night with every breath and b have to adjust the setting after it is implanted and B optimized the setting and it works good.

>> Is that something that no matter regardless of your age you could be a candidate or is it is it so adults don't in adults like no editing and error but your studies are being done for the pediatric patient also for certain patients who have Down's syndrome and they are not able to use any masks so so there are good results with that too and the implant would be preferable.

Sure ideal.

I know that doctor would like to talk about EHI regarding sleep medicine but we did have someone else who called in and wanted to ask you a question.

He wanted to know if it was common for a family to have two family members with the same sleeping disorder.

>> Yeah so yes that's a very good question I guess Boutiette family yeah so immediate family so if someone has sleep apnea so so it is more common and if someone has insomnia that could be narcolepsy could be common in the family so yes.

Did they could be on because of suppose someone has sleep apnea so they inherit the same morphology from the parents if there is passes narrow and they are snoring maybe they have sleep apnea.

>> So you know and we usually when we get into the fall months, you know, we're starting to talk about holidays and things like that.

You're talking about family members having issues.

Yeah, we've had some doctors come in the past and they're like, hey, you know, with Thanksgiving not to worry is not that far away.

Think about making sure other people in your family know when you get diagnosed with something you know I mean because not like you I didn't even think about sleep disorders being, you know, a genetic or hereditary.

>> Yeah.

So it is more common in a family like yeah OK. >> Yeah it's always good to know.

Yeah.

One more thing I wanted to mention about your treatment options so so did the type of sleep apnea that would be called central sleep apnea in there the brain fails to give signal to breathe so sometimes for those patients this seapower bipap the advanced treatment called S.B those those things does not work or they are not able to tolerate.

So we have new treatment option for them that is also implant we call for an economic stimulus and therapy remedy so that is implanted by cardio cardiologist and then be manage that situation so so that is also one implantable option for central sleep apnea also.

Yeah, it's amazing to hear all these advances.

I have no idea you could do that if you are talking about and it's an internal implant.

>> Yes.

Yes.

So Ehi is something we hear about it so much again you and I were talking before the show and I said I'm not sure what to think about it.

I think there's definitely good but then there's also some areas that were becomes worrisome.

How is it playing a role in sleep medicine or do you see it playing a role greatly in the future?

>> Yeah so I'm very optimist and I'm playing a huge role in sleep medicine because accumulate a large amount of detail I couldn't be too sleepy studying the night around eight our data home sleep study again like No six to eight hour data so so this data and we get a lot of geological data so so is helping to to predict like you know OK like this this person is having like now this apnea going on oxygen is running low so it's helping to be more efficient to to read like body studies and Escoto these studies and also the same data and same algorithm a lot of like companies are putting into a smartwatch or like snoring.

So they are like not taking the same concept and putting all the algorithm in that.

So that is available to regular consumer like people are like no being like you know, smartwatches ring and all those things.

So that can also give data like know whether someone is having low oxygen in the night or like you're making up too frequently those are not 100 percent accurate.

They are like maybe 60 to 80 percent accurate but over the period of multiple nights they give like some idea like you know, whether someone is at risk of certain conditions or not.

So so that way it helps.

But for someone who have a lot of anxiety and they are looking like, you know, those data are too much and because of the anxiety they are not sleeping.

So so I would recommend not to use for those people so well and you have brought some images of of the tests that you know, whether you do home testing or sleeping in the lab .

>> Yeah.

So are you saying like if you did a home test you you know, you could be wearing or be hooked up to something that would give you give all this data to you?

>> Yeah.

So instead of them having to go to sleep and be gone.

Yeah.

So so that is very compatible like doing the study at home.

>> So this graph you see this is the widespread home sleep study and in the middle you see that is something like a drop in oxygen.

Yes.

And because of that drop like you know and in different usage of the sleep so.

So in this image you see so a lot of like sleep going on because of that oxygen is dropping and this patient is like saying that sleep apnea so very bad one.

>> And you know, it's interesting I think a lot of people don't realize that they have poor sleep or that they're restless until your you know, until you have a spouse like my husband is in denial.

>> He's still after twenty four years of marriage in denial that he snores.

Yeah.

he doesn't believe it but my kids know it and I know it.

Yeah.

And it's just funny about my mom was the same way she didn't know that she was snoring until my dad you know after they've been married for decades he said you know you're starting to snore a lot.

She had sleep apnea.

Yeah.

So sometimes you know other people in the household would think what would help you?

>> Yeah.

Yeah but sometimes people don't listen so yeah.

So I have like seen some stuff like you know your spouse they do video recording and then like this or that or someone living alone and when they are going on vacation sitting room and they being told like you know hey you snore so but but like no DEA they they can help like these people who are like not living alone and they can give some idea like you know what is going on with the sleep so definitely I we only have a couple of minutes left but I want to make sure we get in.

You had done a talk about quantity versus quality sleep so I don't know if you want to kind of give your little spiel about that because I think people would love to hear if it's IGB to take stock on quantity versus quality sleep.

A lot of people have like these type of problems.

They are not having good quality sleep or sometimes people are sleeping seven to eight hour and they think this is enough but that is not so.

So that's why I gave you talk to educate the public to check their quality sleep many be before before they like no develop like no other health conditions and body like no fixing the sleep they can longer and healthier.

>> Yes I've heard that sometimes if you don't get much sleep for most of your life or if your sleep is broken up, you know you get two hours here.

>> I know that that not good that it doesn't it doesn't make up for one full restful night.

>> Yeah.

>> Yeah.

What do you recommend for your average healthy adult?

What how many hours of sleep should we strive so seven to nine hour of sleep is considered good OK and but like no that would be quality sleep if they are like no after seven to nine hours of sleep if there is to feeling like sleepy tired it means like not the quality of sleep is not good so need to be checked and what would you say as you get kazal here some people as they get older they feel like they need less or I know my grandma got to the point where she just couldn't sleep more than like five or six hours.

>> She just I don't know if that's a disorder or is that common as you get older.

So that is common as we is.

The requirement of sleep goes down, people sleep less but whatever they are sleeping it should be quality sleep OK?

>> Yeah.

All right.

I don't know if we have time to quickly get this one question in some this was a sleeping supplement.

Gabapentin is that yes, the government needed medication that we use for certain like no problems like restless leg or neuropathic pain or sometimes for insomnia as well.

So so that helps in certain situations but it is not over-the-counter medication prescribed by doctor like not deemed it appropriate.

>> OK, right yeah I would I would definitely take that from his advice to heart on everything but especially check with your doctor before starting to take any of these any of these supplements even if they're natural and over the counter.

Yeah play it safe right.

If.

>> All right.

Well Dr. Verber, so nice to have you on.

Thank you for having me, haven't you?

And like I said, we always learn so much from our guests.

Appreciate that.

Yeah.

Thank you.

And I hope you have a wonderful rest of the night.

I hope you get a good rest tonight.

RESTful night this evening.

I'm Jennifer Bloomquist.

Take care.

We'll be back next Tuesday Mark Evans will be hosting another HealthLine.

>> Take care.

Have a good rest of your week.

Yeah.

Thank