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Welcome to the Oprah Online studio.  We are joined this evening by Dr. Martin
Scharf, one of the country's leading experts on sleep disorders.  He was
featured on today's Oprah show about "Night Terrors."  Tonight he hopes to
answer some of your questions about troubles you have sleeping at night and
put to bed some of the misconceptions behind sleep disorders.

If you are getting a good night's sleep, count your blessings.  At least one
in every three Americans are tossing and turning because they suffer from
some type of sleep disorder. Just the number of sleepwalkers may surprise
you.  According to researchers, 24 percent of all men and 9 percent of women
have experienced at least one episode of sleepwalking in their lifetimes.

Lack of sleep has big implications for workplace performance, productivity
and also how comfortable one feels day to day.  There are several serious
sleeping disorders, such as night terrors, which can cause lots of families
strife when left undiagnosed and untreated. Many heighten the potential for
injury one can cause themselves and others while actually being asleep.

Dr. Martin Scharf was the Associate Director of the first Sleep Disorders
Clinic in the country and has remained active in the field of Sleep Disorders
Medicine ever since.  Currently, he is the founder and director of the Center
for Research in Sleep Disorders located in Cincinnati, Ohio.  Welcome Dr.
Scharf!

Question:       I was never really aware of night terrors.  After watching
the show and being aware of it, do you think it is likely to happen to me???
Dr. Scharf:       No.  Night terrors happen in only one % of adults.  To
avoid them, be sure you get enough sleep.

Question:       I heard somewhere that you shouldn't exercise within 5 hours
of when you are going to sleep.  Is that true?
Dr. Scharf:       Exercise too close to bed time can make sleep difficult but
only for those who have insomnia.  If you have no trouble sleeping normally,
exercise in the afternoon will actually increase the depth of sleep.

Question:       Hi, do you suggest taking melatonin?  If so, what dosage do
you suggest, oral or sublingual?
Dr. Scharf:       Wonderful question.  We don't know much about melatonin,
but believe that it is helpful in regulating circadian rhythms, especially in
the elderly.  The regular dose is 3-6mg taken about a half hour before bed.
But it should be taken between 9-11pm, if taken too early, it probably won't
help.

Question:       Dr. Scharf, I hear conflicting reports on waterbeds.  Please
tell me, are they good or bad?
Dr. Scharf:       There is no data suggesting that any particular surface
provides any benefit compared to any other when it comes to sleep.  When it
comes to waterbeds, the key is probably temperature.  If it's too cold, you
are too cold!  If it's too hot, you'll be sleeping on the couch!

Question:       I am not tired at night and have to force myself to sleep.
Then I'm tired the whole next day. What do I do?
Dr. Scharf:       The question that you need to ask is, if you are able to
fall asleep later at night, your problem may be a circadian problem. This is
another way of saying that you may have your days and night mixed.  You may
want to buy a light box and get bright light exposure in the morning.
Another idea might be the alarm clock that has a gradual light source as the
time of your awakening approaches.  If these don't help, contact a local
sleep clinic.

Question:       Please help.  My family and friends get mad, I lose jobs and
become irresponsible with appointments.  It seems that my body wants to stay
up at night and sleep during the day.  I have tried multiple doctors
including therapy and meds meds meds.  What shall I do?
Dr. Scharf:       You have your days and nights mixed.  A consultation with a
local sleep clinic will probably lead to "Phase Advance Chronotherapy."  This
is simply moving your body clock forward.  Usually people can re-set their
internal clocks.  Good luck.

Question:       Is there any way to prevent awful nightmares.  I have them
about my abuse, being stalked now and my foster kids?
Dr. Scharf:       Recurring nightmares are very painful, but they are often
what we call "lucid dreams."  This mean that during them, you are actually
aware that they are happening.  It is important to remember that the only
dreams we remember are the ones we are dreaming when we wake up.  Knowing
this means, that dreams have no endings because we wake up from those that
are happening while we awaken.  The secret to handling a recurring dream is
to rehearse it during the day and create an acceptable ending.  This will
enable you to do the same thing at night and make the dream less frightening
and hopefully disappear.

Question:       When night terrors were described earlier in the show it
seemed to me that initially these could possibly be misdiagnosed as fuges?
Do I make any sense?  Could you comment?
Dr. Scharf:       You make perfect sense and some could be seizure disorders
or confusional states.  An overnight sleep study will usually make a clear
distinction.

Question:       How do I make myself have more nightmares?  They're harmless
and a thrill.
Dr. Scharf:       Purchase a book called "Lucid Dreaming" by Philip LeBarrge.
He describes how you can train yourself to control your dreams and have some
of life's wildest sleep experiences.

Question:       I heard from the new Gallup poll that many more people are
having sleep disorders now than several years earlier.  How should the US as
a society handle this?
Dr. Scharf:       The average American gets two hours less sleep today than
they did at the turn of the century.  Indeed, we institutionalize sleep
deprivation by having our children overwhelmed by activities and homework,
and needing to get up early to catch the bus.  For adults, we need to lobby
our local TV stations to put the news on at 10 instead of 11pm, since most
people go to bed right after the news.

Question:       I have trouble sleeping.  I just can't stop thinking about
work.  Any suggestions?
Dr. Scharf:       You may not have trouble sleeping, but instead have trouble
relaxing , or turning your mind off.  Relaxation tapes are an effective
electronic form of counting sheep - and they work.  Also, bio-feedback can be
helpful.  You too could get help from a local sleep clinic.

Question:       No matter what time I go to bed, I always wake up at the same
time and I can't go to bed earlier.  I'm a wreck!  What can I do?
Dr. Scharf:       The problem is not what time you are waking up but what
time you go to sleep.  Take as hot a bath as you can stand two hours before
bed.  You should stay in the tub long enough that your body temperature rises
and you perspire.  Over the next two hours, as your body temperature comes
down, you will be facilitating the process that normally makes you sleepy.
Adding melatonin a half hour before bed can also help.

Question:       I am overweight, have Graves Disease, and snore heavily.  Is
the snoring coming from my weight, or could it be something more serious?
Dr. Scharf:       Snoring is likely coming from the increase in neck size.
As the circumference of your neck increases, the diameter of your airway
decreases.  Sometimes, blood pressure increases in snoring people, therefore
you may have sleep apnea.  You sound like a good candidate for a clinic
consultation.

Question:       How can you be tested for sleep apnea?  Where could someone
go if they think they have it?  My husband shows some signs but is afraid to
be tested.  It is causing me to have problems sleeping because he is so
restless and walks in his sleep.
Dr. Scharf:       If you don't have a well known sleep clinic in your area,
contact either a pulmonologist (lung specialist) or a home health care
company.  Studies can often be carried out in your own home, from your own
bed.  This will make him more comfortable, but as Nike says, "Just do it!"

Question:       I have lost jobs, had family members call me names, and
friends think I am terribly irresponsible.  I have tried relaxation, therapy
and medications.  NOTHING WORKS!  Am I a hopeless insomniac?  I have to
function by day cause I am a salesman! HELP!!!
Dr. Scharf:       I do not believe that insomnia is hopeless, but often, it
doesn't resolve by itself.  Find a sleep specialist.  You can be cured.
Sleep well.

Question:       I wake up 4 or 5 times a night - very light sleeper I guess -
any way to improve sleep?
Dr. Scharf:        We must know why you are awakening.  It could be something
physical - like breathing changes or body movements.  Discuss this with your
Doctor.  If it is effecting your daytime alertness and energy, it needs help.

Question:       I nearly always get enough sleep, but for some reason, I am
always tired and falling asleep.  Any explanation?
Dr. Scharf:       If you get the right amount and the right kind of sleep,
you should not be tired during the day.  This is a sign that something is
either wrong at night, or may be a symptom of biochemical imbalances, like
some types of depression.  This is a clear signal that you should get help
before you fall asleep on the road.

Question:       What causes sleep disorders in the elderly, especially
insomnia?
Dr. Scharf:       As we age, sleep gets lighter and more fragmented.  It
seems like good sleep is wasted on kids that don't appreciate it.  Our need
for sleep remains the same but our ability to get it diminishes with age.
Causes include: pain, medical illnesses, medication, apnea - very common in
the elderly, and leg movements.  Most sleep difficulties can be treated.

Question:       What are some of the new things happening in treatment?  I
sleep with a cpap 7000 but am again having problems..is there any surgery
that can help?..I have lost 90 lbs so my face wrinkles up and lets air in the
mask..help....
Dr. Scharf:       You may need an adjustment in the size of the mask.  The
newer masks seal much better.  You may also be ready to graduate from the
mask and move onto a dental appliance.  These pull your lower jaw forward and
widen your air space.

Question:       My husband snores horribly and refuses to see a doctor about
the problem.  What can I do?
Dr. Scharf:       If he has no other symptoms other than snoring, you might
try the Breathe Rights.  These are the bandages you see football players
wearing.  They actually work for many snorers.  He needs to know that snoring
can lead to sleep apnea with a whole host of consequences.

Question:       I suffer from not being able to sleep at night.  I have
terrible nightmares that cause me to never go through a restful night.  I am
taking a drug called Doral.  Are there any side effects?  I am worried about
addiction to the drug.  Please help!!!!!
Dr. Scharf:       The only dreams we remember are the ones we wake up from.
Your frequent dreams mean you are experiencing frequent awakenings.  Doral is
not supposed to be taken long term.  We have completed a study evaluating the
combined approach of using Doral with relaxation tapes.  It works and many
patients continue to sleep well after stopping the medication.

Question:       What are the usual suggestions for someone with sleep apnea?
Dr. Scharf:       Get it documented in a sleep laboratory.  The most common
treatment is nasal cpap.  Other treatments include dental appliances; surgery
has a relatively low level of effectiveness, but in younger patients with
milder cases, it is a reasonable choice.  Also remember that alcohol in the
evening can make it worse.

Question:       How do I adjust to my newborn waking during the night?  I am
unable to nap when he does.
Dr. Scharf:       Fortunately for you, your newborn will be a different
person every few months.  The chances are he or she will slip into a pattern
that you can adjust to.  Your problem is not the daytime nap, it's your
nighttime sleep.  When he or she sleeps through the night, you won't need the
nap.  I've been there, God love you and good luck!

Question:       When should you go to a doctor about your sleeping habits?
Dr. Scharf:       If you're tired or sleepy during the day, despite getting
what you think is an adequate amount of sleep, something is wrong.  If you
are waking up somewhere else than where you went to sleep, you have a
problem.  Sleep varies from individual to individual.  The key is how do you
feel during the day.

Question:       Is waking up at night and starving a sleeping disorder?
Dr. Scharf:       I don't think so.

Question:       In the last 3 years I have not slept over 4 hours a night.  I
wake up and I am so tired but when I fall asleep again I just wake up in 1 to
2 hours.  This goes on all night.  What could be the cause of this?
Dr. Scharf:       A long list of problems including depression and sleep
apnea.  Please see a clinic.

Question:       Is a late afternoon nap a bad idea?
Dr. Scharf:       Not if you have no trouble sleeping at night.  However, the
longer the nap, the greater the chance of disturbing night sleep.

Question:       I can't take any addictive drugs.  What drugs are available
that do not have addictive short life qualities?
Dr. Scharf:       At this time we believe that ambien has the lowest
addiction potential of any prescription sleeping pill.  However, we do not
believe that you should take a sleeping pill nightly.  Try and add in
behavioral techniques.  Contact my lab for a more in depth answer.

Question:       What is a night terror?
Dr. Scharf:       A night terror is considered a disorder of arousal. It
occurs during the deepest sleep, often is associated with sweating, increased
heart rate, overwhelming fear, and very little recall.  It occurs in a mild
form, commonly in children, but can occur in a severe form in adults and may
also include sleepwalking.

Dr. Scharf:       Thanks for the great questions.  I hope I helped.

Thank you so much for joining us tonight!  You can reach Dr. Scharf at the
Center for Research in Sleep Disorders, Inc., 1275 East Kemper Road,
Cincinnati, OH 45246.  The phone number is [phone].  We wish you all
luck  - and a good night's sleep tonight!  Thanks again to Dr. Scharf for
joining us.  Goodnight from Harpo Studios.