Helene Emsellem, MD
Biography

	How does a lack of sleep affect a person? How does stress affect sleep? Does exercise really help us sleep better? How long does it take to get results from a sleep study? How are some common sleep disorders treated?

Is stress keeping you from getting the sleep you need? Or is a lack of sleep causing you stress? Or maybe you're just so tired you don't know which came first anymore! Helene A. Emsellem, MD, medical director of The Center for Sleep and Wake Disorders, joined us Oct. 20, 2005 to help break the stress-sleep connection.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

This WebMD University course is brought to you by Medical Mutual.

MODERATOR:
Welcome to WebMD University: "Letting Go." Your instructor today is Helene A. Emsellem, MD, medical director of the Center for Sleep and Wake Disorders.

Thank you for joining us today, Dr. Emsellem. Please tell us a bit about yourself, and why you chose to focus on sleep issues.

EMSELLEM:
I am a neurologist with specialty training originally in epilepsy.

As I was running the epilepsy lab at George Washington University Medical Center, I became interested in sleep and decided my monitoring equipment could be used to monitor sleep at night. I have been fascinated by sleep ever since.

The early 1980s, when I got involved with sleep, was a time when we were just learning about sleep apnea, and sleep disorders as a branch of medicine was in its infancy. We have come a long way since, but there are still many fascinating questions about sleep.

EMSELLEM:
In order to wake up in the morning feeling well rested, you not only have to sleep an adequate amount of time, but you need to cycle through the five stages of sleep in an orderly sequence and to spend enough time in each stage.

Disruption of the quality by episodes of breathing disturbance, reflux, joint pain, the cat in the bed, can all affect and negatively impact how you feel the next day. You may wake up tired and achy; you may also be less mentally sharp and more irritable.

Most adults require seven to nine hours of quality sleep per night in order to wake up feeling their best.

MODERATOR:
Yet so many people swear they only need 5-6 hours of sleep per night. Are they fooling themselves?

EMSELLEM:
Yes. Many people will say that they only need five to six hours of sleep per night, but they are usually not doing this on a regular sustained basis. Studies have repeatedly showed we need a minimum of seven hours of sleep per night in order to function optimally.

"Stress affects sleep very negatively."

There is an interesting floor effect in sleep deprivation. Studies that have been done with chronic sleep restriction down to six hours a night and four hours a night show very little difference in function, so we can survive compromised on less sleep. But the toll it takes on our physical and mental well-being is huge.

I believe that if those same people would take a two- or three-week period and allow themselves the pleasure and opportunity to get enough sleep, they would appreciate an enormous improvement in their well-being.

EMSELLEM:
Stress affects sleep very negatively. When we're under stress, we have trouble initiating sleep. After a stressful day it's not only hard to unwind mentally, but we may be tense and it may be hard to unwind physically enough to initiate sleep.

In addition to the problems getting to sleep, when we're under stress we may not be able to sleep continuously through the night. Particularly, early morning awakenings at 3:00 in the morning or between 2 to 5 in the morning may occur during periods of stress.

When an individual awakens at this hour for no clear reason, it's often difficult to fall soundly back to sleep, and then you may start the next day even more tired and less able to cope with your stressors. In periods of stress, allowing a wind-down time in the evening can be very helpful. You might try:

• Using a diary to make a list of things you have to deal with
• Taking a warm bath
• Doing some yoga or stretches

MODERATOR:
How does excess weight affect sleep?

EMSELLEM:
Individuals who are overweight or obese are at higher risk for having obstructive sleep apnea.

In apnea there are periods of stoppage of air flow at night, often punctuated by snorts and arousals and this disturbs the quality of sleep and can leave these individuals tired in the morning when they awaken.

Being overweight can also increase the risk of reflux, which disturbs the quality of sleep, and for the morbidly obese, it may be difficult to get comfortable in bed because of the weight, which may disturb sleep, as well.

There's another interesting relationship between weight and sleep: if you are sleep deprived, you are more likely to be overweight and obese. Good sleep and adequate amounts of sleep increase the probability that you're at your optimal body weight.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician.