Jô Soares - Medicina do Sono (parte 1)


Uploaded by medicinadosono on 05.01.2012

Transcript:
He is an expert in sleep medicine
and works for highway transport companies.
Sergio Vieira, come on over here!
- Sergio, you are a pneumologist doctor and your specialty is sleep medicine
- through the Saint-Antoine Hospital in Paris
- and you are vice president of the Brazilian Association of Sleep
- Exactly.
- What is the connection between sleep and pneumology, if there is one?
- Yes, there is one.
- The most common sleep disorder is the respiratory one
- That's how I became interested in sleep
- The Obstructive Sleep Apnea syndrome, which is associated to snoring
- people that can die due to this, right?
- Yes. They can die due to cardiovascular complications.
- From this interrelation I got interested in sleep.
- But can they choke to death as well?
- Well, not die. Unless the person has some type of cardiac repercussion
- If they have a sudden drop in oxygen levels,
- then they can suffer complications.
- What is frequent is that, when the person chokes,
- they wake up very scared, and get up,
- and as they get up, this would be a defense mechanism.
- I'm geting breathless. You can't imagine...
- We begin to yawn.
- So, for those who do not know, what exactly is apnea?
- Apnea is when the person stops breathing while sleeping
- including when the person snores, right?
- Snoring is the most common clinical sign.
- It's like choking during the snoring
- That is the dramatic sign of apnea,
- but when this happen, there is a severe variation in the intrathoraxic pressure
- normally it is -10, and when apnea occurs it becomes -60,
- so it greatly increases.
- There is a very large variation at this time
- and that is when cardiovascular complications can happen.
- For example, people who die asleep,
- or as some people say "woke up dead".
- "woke up dead". Never heard that before!
- These people have cardiac complications that happen during sleep
- What we know about the stage of sleep when we dream,
- is that at this moment, there is an important modification in the cardiovascular physiology
- What is the percentage of people that "wake up dead" ?
- Or that "die asleep" ?
- Is this number important?
- I don't know, but sleep apnea attacks about 5-9% of the general population
- But not all of them die?
- Not all die, but some may develop high blood pressure, for example,
- which is secundary to sleep apnea.
- Because in a certain way, it is always considered a blessing to die asleep, isn't it?
- You remind me of a joke I heard recently, from someone who says:
- "I would like to die in the same way as my grandfather,"
- A tragic joke, right?
- The other guy, asks: "Why?"
- "he died asleep"
- I just don't want to die in the same way as the passengers of the bus he was driving...
- I don't think it is comfortable, do you?
- So I'm going to reword this
- People say it is a blessing for the person to die in bed
- They say good night to the family, “see you tomorrow”, lie down and it's over.
- Maybe you could consider it a privilege.
- Isn't it?
- Perhaps
- You know, there was a famous American composer, Irving Berlin
- He composed White Christmas, a bunch of things
- and continued to work and play to his 102 years of age
- At the age of 102, on one evening after dinner,
- he played piano and said "Ok folks, see you tomorrow, I am going to bed"
- He laid down and died at the age of 102,
- and never had any type of complication
- I don't think he died. I think he simply wiped out
- In this specific situation, which is not what happens to the majority of people,
- I would say the same you did
- I wish I could go up to 102 years, say good night and go to sleep
- I mean, despite you being a specialist, it's a good thing, isn't it?
- Yes, probably.
- It is probably more comfortable than the other types of death.
- Of course
- for example, the driver that fall asleep
- and you, that have nothing to do with it, go away along with his sleep
- You work with many highway transport companies, don't you?
- I assist a company that transports passengers and load, Viação Águia Branca,
- where we monitor about 1,500 drivers
- and we developed a prevention and education program
- related to drowsiness
- which is a factor that leads to high levels of death,
- not only here in Brazil
- In England, 20% of accidents occur due to drowsiness.
- You know, I had an uncle, who was a legend in Brazilian Basketball
- Renan Soares, also known as Canela
- world champion twice as the coach
- He stopped driving because he would systematically sleep behind the wheel
- He had the wisdom to stop when he once woke up on top of a tree branch,
- so he thought it would be better to stop.
- Is there a cure for this type of drowsiness?
- There is
- It is in identifying the cause.
- As in your uncle's case, it was probably sleep apnea.
- Sleep apnea is an entity, a sleep disorder that has treatment.
- But the person gets drowsy? They start driving and
- Yes. They fall asleep
- But they don't snore?
- Not necessarily, because you may have other causes for this
- For example, the excess of work load,
- the individual that drives 10 to 12 hours at once
- enters the risk zone due to fatigue and may fall asleep.
- we know the hours that accidents are most frequent
- between 3 and 7 pm and also between 2 and 7am
- So you have a relation with the biological clock
- But some people believe that “can pass this block, I can make it”,
- and they don't make it afterall
- It's as if we are recording here,
- and suddenly there is no light in the studio, everything goes black
- That's how it is.
- Some people pass through cities and don't remember that they were there
- Do you monitor many drivers to make these statistics?
- Yes, we created a program, and within the program we have diagnosis methods
- We use an assessment with a watch,
- an english system, called actigraphy
- so we evaluate the muscular activity
- As the muscular activity decreases, the presence of drowsiness is suggested
- and we interfere
- We monitor the person during 12 days
- and we will check if he sleeps well, his sleep quality,
- and when he's driving
- what level of wakefulness he remains in
- There is something curious:
- There is eventual drowsiness,
- I remember that many years ago I was recording with Zelone,
- and soon after, before arriving in Santos
- I left the recording set, which I believe ended around 4am,
- and as I am an owl
- I thought it would be better to leave, go to sleep
- and wake up the next day ready to record.
- I took the car and left.
- When I was half way around the mountain, of maybe a bit before the mountain
- I felt drowsy.
- I had no doubt:
- I parked on the shoulder and fell asleep
- I was waken by officers,
- who recognized me and asked me what was going on
- I explained that I was feeling drowsy and that I stopped to take a nap
- They say I did the right thing
- Are there people that resist this?
- Yes. They resist and die!
- Besides being tragic, insisting and dying
- All the accidents caused due to drowsiness have large impact in general
- because when you crash, you are totally loose.
- There is not a foot on the breaks, nothing.
- There is absolutely nothing
- Unfortunately what people don't do is what you did
- We know that if you stop and sleep for half an hour,
- you could drive for another 4 to 5 hours safely,
- because when we sleep for 20 minutes,
- we pass through all the stages of our sleep
- and it recharges our battery.