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Millions rely on sleeping pills for relief, but many of the medications cause dependency or serious side effects. What are better options? A breakthrough gene therapy saves a newborn in the US.
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00:00Did you sleep well?
00:09If not, you're not alone.
00:11Sleep problems are as old as humanity itself.
00:16Some of the very first known medicines were sleep aids.
00:19Take rooibos tea, said to reduce stress.
00:21It's still used in southern parts of Africa as a traditional part of the evening routine.
00:29And in traditional Chinese medicine, jujube has been used for centuries to treat insomnia.
00:38In Germany, a recent survey showed that one in four people take prescription sleeping
00:43pills, despite the risk of dependency, but there are alternatives.
00:49We'll look at those and much more on this edition of In Good Shape.
00:57Trouble sleeping?
01:08You're not alone.
01:11At least 10% of adults worldwide struggle with insomnia, difficulty falling asleep or waking
01:18during the night.
01:21Anna knows how poor sleep impacts daily life.
01:25I notice, after a few nights that weren't very restful, that I start to feel thin-skinned.
01:34Sleep is vital.
01:35Our body and brain needs rest.
01:38Healthy sleep clears out our brain.
01:41While we sleep, cerebrospinal fluid washes between nerve cells, absorbing then flushing out the
01:47day's waste.
01:50When we wake up, our brain has been refreshed, which is key to it functioning properly.
02:00Here in a sleep lab, experts can see if sleep that felt restful was also restorative, by analysing
02:08brain waves.
02:10High amplitude waves are characteristic of restorative sleep.
02:16On sleeping pills, especially benzodiazepines, in the sleep lab, we see that these slow waves
02:23flatten out.
02:27While helping to fall asleep quickly, two commonly used medications can cause dependency in a short
02:32period, benzodiazepines and so-called Z-drugs.
02:36There's solid evidence showing this, benzodiazepines flatten deep sleep the most, but Z-drugs also have
02:44the same effect.
02:48New research indicates that these sleeping tablets interfere with the brain's cleaning
02:53processes, leaving harmful deposits behind.
02:57Although not conclusively proven, doctors still advise caution.
03:01We have to be cautious with conclusions at this point, but there are indications that benzodiazepines
03:10can actually promote the development of these serious diseases, like dementia for example.
03:23Dementia caused by sleeping pills?
03:26Most suspect it's true.
03:28And that's why they advise against using them in the long term.
03:32At this Hamburg clinic, Dr Peter Strater, and his team, often encounter problems caused
03:37by sleeping pills.
03:39The side effects can mean you're not really awake the next day, or that you don't feel refreshed,
03:48and that night you do the same thing all over again.
03:51A clear sign of dependency.
03:54But few people are able to admit this to themselves.
03:58Patients sense they're dependent, but they're in denial.
04:02They are dependent, but they know it's bad, so it can't be true,
04:06making things even more complicated.
04:09A new drug on the market works differently
04:11from most commonly used medications.
04:14It's said not to be habit-forming, but research isn't clear.
04:18There are patients for whom it's very effective.
04:23And they feel much better, especially during the day.
04:27This substance seems to have that effect on some people.
04:31However, many are also disappointed.
04:34Sleeping pills were out of the question for Anna,
04:37so she went to a sleep course.
04:40If you just take medication, you haven't changed the circumstances.
04:46I don't want to numb myself.
04:49I want to approach the issue in a conscious way.
04:52And I want to find a good solution for me that is going to last.
05:01On the quest for a long-term solution, she went to neurologist Paul Bayer,
05:06who suggested a sleep course, a behavioural therapy program with a psychotherapist.
05:13I've really learned a lot at the sleep course, and it's given me tools that I need.
05:19These include simple tips, like sleeping in a room without your cell phone,
05:24but also understanding you can't force sleep.
05:27When I try hard, gritting my teeth, thinking I have to fall asleep or else disaster,
05:35that's one aspect.
05:37But then there's another aspect, which is the biological phenomenon.
05:41So there's the psychological element, but that increases our stress hormones,
05:46and then those in turn keep us from sleeping.
05:49So it's the mind-body connection that can trap us in a spiral.
05:54In group therapy, she learns how to deal with a bad night.
05:58The trick?
05:59You're the expert of your own life, even with not enough sleep.
06:03You know, okay, the night wasn't good, but there are things I can do to help myself during the day,
06:11like breathing exercises.
06:13I have the resources to get through the day because I'm experienced and have a routine at work.
06:20Less stress and confidence in her own abilities.
06:24That's what she's learned here.
06:26Problems sleeping are worth addressing, but medication isn't a healthy solution long term.
06:38Another risk of sleeping pills is the strain they place on the liver.
06:42That's where their active ingredients are broken down, a process that can damage the organ.
06:47The same holds true for certain dietary supplements.
06:50Highly concentrated curcumin capsules or green tea extracts may seem harmless at first,
06:56but even these can cause liver enzyme levels to spike after only a short period of use.
07:03In Germany, manufacturers of medicines must officially disclose harmful side effects,
07:09for example with antibiotics, painkillers and some herbal medicines.
07:14But there's no such requirement for dietary supplements, because they're considered food,
07:19explains pharmacologist Martin Smolik.
07:23With herbal medicines, liver damage is investigated and recorded, but not with dietary supplements.
07:30So from supplements we have reports of liver damage, but no data.
07:35In the cases of liver damage with no known cause, the authors of a large US study recommend asking about the use of dietary supplements.
07:48The scientists focussed on tumeric, black cahoosh, green tea extract, ashwagandha, garcinia cambogia and red yeast rice.
08:05Most common is tumeric, a traditional spice and medicinal plant.
08:13It contains curcumin, which can aid digestion and have a mild anti-inflammatory effect.
08:21It is also said to prevent heart attacks, strokes and cancer.
08:25But there's no clear scientific evidence for many of these effects.
08:30Nevertheless, some manufacturers offer particularly high dose extracts.
08:35Pepperine is often added to increase absorption, which also increases the risk of overdose.
08:42The pharmacologist also warns that people react very differently.
08:47The risk is not always dose dependent because of different genetic predispositions.
08:52Some immune systems mean that even very low doses can cause liver damage.
08:57With others, it would take much higher doses. It's unpredictable.
09:01People whose liver is already damaged are particularly at risk of toxic effects from dietary supplements.
09:09For example, due to diet-related fatty liver disease, which affects one in three people without them knowing, or due to alcohol damage and inflammation.
09:20A damaged liver is twice as vulnerable. It no longer functions or detoxifies properly.
09:27And then, because of the pre-existing damage, even small additional attacks are enough to completely destroy the cells that are still functioning.
09:37Pharmacist Dorothy Dutch advises people on multiple medications and warns them of interactions with dietary supplements like cholesterol-lowering drugs.
09:47If a patient is prescribed a statin and says, well, I'd like to do something good for myself and add something herbal.
09:57And I read on the internet that red yeast rice is good.
10:01Then they might put both together, but that adds up.
10:05But for regular kitchen use, the experts aren't concerned.
10:10There's no need to worry about using turmeric as a spice or drinking a cup of green tea.
10:16This is about concentrated supplements.
10:20The recommendation? Get advice and involve your doctor or pharmacist to protect your liver.
10:27Our liver works tirelessly, filtering toxins, storing energy, and keeping our metabolism humming.
10:39But we often take it for granted until something goes wrong.
10:42There are over 100 known forms of liver disease.
10:46One is the extremely rare CPS1 deficiency, a genetic disorder that can be life-threatening for newborns.
10:53But now there's hope.
10:55U.S. researchers have developed the first custom-made gene therapy to specifically target this condition.
11:02This is Kyle Jr., or KJ for short.
11:07Shortly after being born, he was diagnosed with CPS1 deficiency.
11:12CPS1 is a vital liver enzyme needed to remove ammonia from the body.
11:18However, KJ was born with a genetic mutation which causes levels of ammonia to become toxic.
11:25Many children with this condition die at a young age.
11:29KJ had to be put on a low-protein diet and was given medication.
11:34But it wasn't a long-term solution.
11:37His parents were faced with a difficult choice.
11:40They had to choose between a transplant or an unproven drug therapy.
11:45We either have to get a liver transplant or give him this medicine that's never been given to anybody before, right?
11:54I mean, what an impossible decision to make.
11:58KJ's parents chose the latter.
12:00They wanted KJ to be able to lead his normal life as quickly as possible.
12:05With the help of a new therapy based on gene editing, researchers in Philadelphia were able to partially correct the mutation.
12:14Rebecca Ahrens-Nichlas and Kieran Wissanaro are two of the study's authors.
12:20Gene editing uses CRISPR technology to address misspellings in the DNA, and DNA is a long sequence of letters, to actually find a misspelling and correct it.
12:32So misspellings in the DNA can cause devastating diseases.
12:36With gene editing, we can correct those misspellings and hopefully definitively treat those diseases.
12:42Unlike traditional CRISPR methods, a newer method can change single DNA letters without cutting strands.
12:51So it's considered safer.
12:53The researchers developed a drug specifically for KJ.
12:57They tested it in cells, mice and monkeys before giving it to him via infusion after about seven months.
13:04Researchers are calling it a record-setting timeline.
13:09This study is a milestone, a real step forward, simply because it shows that it's possible at all to perform such specific editing for a single patient in a relatively short period of time.
13:26The new gene therapy is also a milestone because it works.
13:31After just two treatments, KJ was able to consume more protein and the ammonia blockers could be reduced.
13:38What was really telling for us is that he had a couple of infections in the month or two after he started getting the treatment.
13:45That normally would cause the ammonia level to go very high, that would put him in danger, and he tolerated like a champ.
13:53The research team believes that the new gene therapy will help many more people with rare diseases.
13:59I really hope that 10 years from now, targeted personalized therapies are available for most of my patients.
14:06That would be the dream.
14:07For me, it's more than hope.
14:08It will happen.
14:09No, it will.
14:10I mean, now that we have shown the way, we fully expect many metabolic physicians around the world to be, you know, excited about trying to do this for themselves.
14:18And so I think this is the start of something.
14:21Thanks to the new gene therapy, baby KJ may have a long life ahead of him.
14:31For centuries, children were viewed as little adults.
14:36That idea shaped Europe well into the 19th century.
14:40Today, we know that childhood is a distinct phase of life, with its own needs.
14:49But in some ways, the pharmaceutical industry has remained stuck in the past.
14:56Many drugs aren't approved for children at all, because studies on pediatric dosing are rare, seen as difficult, ethically sensitive, and expensive.
15:06For many companies, the research isn't worth it.
15:09As a result, pharmacies often have to improvise and prepare individual formulations, as they do here in Dammstadt, Germany.
15:1830,000 packs of tablets, suppositories and syrups.
15:24660 individual medications.
15:27There's plenty of medicine for adults at this hospital pharmacy in Dammstadt, Germany.
15:32But almost none of it is made for children.
15:35To give medication to a sick child, pharmacist Daniela Burau has to prepare the medicines herself.
15:42Mostly antibiotics.
15:44Everything is produced for adults.
15:47We can't use these medicines to treat children.
15:50They would be massively overdosed.
15:52And the tablets are usually too big for children to ingest.
15:56We, and many public pharmacies, solve the problem by crushing tablets to make new capsules or syrups.
16:04Modifying a medication into child doses is a time-consuming task for pharmacists like Daniela Burau.
16:15But it's even harder for parents.
16:18It's difficult for parents to handle.
16:24The capsules have to be opened and mixed into a puree or a liquid and then spooned to the child.
16:31But if we need to change the dose, it's extremely difficult, because we have to make new capsules.
16:39We can't just give half a capsule.
16:42That doesn't work.
16:44Denise Schmidt has a similar experience.
16:46Her four-year-old has epilepsy and she has to measure out the medication.
16:51I know very little about medicine, but somehow I just have to trust that what we're doing is right.
16:59There are these measuring tubes like syringes, but unfortunately they work very poorly.
17:05So yes, it would be nice if things improved.
17:08In paediatrics, the lack of child-appropriate dosages has long been a problem.
17:14The director of Darmstadt's children's clinic says the insufficient and unreliable supply of children's medicines is not improving.
17:25Paediatrics isn't a big market.
17:28Some conditions are rare, which means there's little demand for the medication.
17:32So there's naturally little interest in conducting studies, which are expensive, cost a lot of money and take a long time.
17:45A limited evidence base and increasingly frequent drug shortages mean that children often have to be given low-dose versions of drugs actually intended for adults.
17:56During inpatient care, an estimated 42 to 90% of children and adolescents are treated with medications used outside their approved indications.
18:07Nearly 40% of all oral medications are altered before they are administered.
18:13That means the drug is chosen specifically for the illness.
18:18But for the children of that age, there's no evidence, no studies showing that it's effective, and above all, not harmful.
18:30Tools such as this digital database in Germany offer evidence-based dosing for children, are a good first step.
18:39But without targeted research and a more reliable supply of children's medicines, pharmacies and parents are often left with only one option, to dose the medication themselves.
18:54More than 1800 years ago, the Chinese physician Hua Tuo is said to have used an anesthetic for the first time during surgery.
19:02Other cultures also experimented early on with pain-relieving substances.
19:09A major breakthrough came in 1846 with the first successful ether anesthesia in Boston.
19:15Since the 20th century, synthetic anesthetics have been used, and since 1989, propofol especially.
19:22But it has side effects, which is why local anesthesia is often the better choice.
19:28Holger Detman is familiar with general anesthesia.
19:32He loves mountain biking and motorcycling, so he's no stranger to injuries.
19:37A week ago, he broke his hand.
19:40Tomorrow, he's scheduled for surgery here at this Hamburg clinic.
19:44And now he's here for his pre-anesthesia consultation.
19:47Anesthesiologist Alexander Tabatsis and his team know that people often fear the anesthesia more than they do the actual surgery.
20:00Because people don't really understand what's going on.
20:04All they know is they're injected with a medication and then lose consciousness.
20:09Holger Detman has also experienced feeling unwell for several days after general anesthesia.
20:15The consultation now focuses on what type of anesthesia is suitable for the operation on the hand.
20:23With general anesthesia, consciousness and pain perception are switched off in the brain.
20:29This is achieved with sedatives, painkillers and muscle relaxants if necessary.
20:38The drugs are injected into a vein via a cannula and sometimes an additional gas is given.
20:47Depending on how deep the anesthesia is, it can suppress breathing.
20:53A flexible plastic tube is inserted into the windpipe so the body can be artificially ventilated and supplied with oxygen.
21:01Even though general anesthesia is generally safe, it places a heavy load on the body and the risks and side effects increase with age and pre-existing conditions.
21:12Nausea or vomiting, a sore and scratchy throat or confusion are all common.
21:18Patients must be informed about this.
21:19General anesthesia is essential for abdominal, cardiac and most head surgeries.
21:26But for almost every other procedure, including Holger Detman's hand surgery, there's an alternative.
21:32With local anesthesia, only parts of the body are numbed.
21:37In this case, the hand.
21:39But the patient stays conscious.
21:40Despite being more gentle, local anesthesia isn't used often enough, says Thorsten Steinfeld from the German Anesthesiologists Association.
21:53All vital bodily functions remain intact.
21:58That means the brain stays awake, lung function remains, as does breathing.
22:04All the important reflexes that keep us alive stay on.
22:09Problems like post-operative nausea, vomiting, possible cognitive issues, memory problems.
22:16Those issues are gone.
22:18And that is a huge advantage.
22:20The disadvantage is being awake and aware during the surgery.
22:28That scares some people off.
22:30But nevertheless, Detman opted for local anesthesia.
22:34It's seven o'clock in the morning.
22:38Well, I'm getting a bit more nervous now that it's about to start.
22:43While the operating room is being prepared, his arm now needs to be anesthetized.
22:47His anesthesiologist is going to use ultrasound to guide a thin needle and deliver the anesthetic precisely in the right locations.
23:02The basic principle of local anesthesia.
23:05The nerves in the area being operated on are selectively blocked.
23:10Holger Detman shouldn't feel anything in his hand because pain signals from the numb nerves can't reach the brain.
23:18The hard part is injecting the anesthetic as close to the nerve as possible without injecting into the nerve itself.
23:25If the needle touched the nerve, Detman would flinch.
23:28But he doesn't.
23:30I'm impressed that the only thing I felt from the anesthesia was the injection.
23:35And a tiny sensation in my little finger.
23:38But otherwise it was completely unnoticeable.
23:40Patients can even choose to watch a movie.
23:44Detman chooses a nature documentary this time.
23:48His doctor thinks his choice makes for a great distraction during the procedure.
23:54This audio-visual setup is new and the doctor says it's very helpful.
23:58Detman is very relaxed and wants to stay aware of what's happening as he's wheeled into the operating room 20 minutes later.
24:08The cast is removed and the surgeon checks whether the hand is completely numb.
24:13The doctor uses force to pinch his arm with tweezers and asks the patient if he feels anything.
24:24But he says he doesn't feel anything. The area is completely numb.
24:28When he's not listening to music or watching the documentary, he can hear the sounds in the operating room.
24:38You can tell that someone is working on you.
24:42And you notice it when a screw is being inserted.
24:45And you can hear them screwing it in, but I can't say you can actually feel it.
24:50The fact that this gentler local anesthesia isn't used more often in German hospitals is sometimes due to surgeons' preferences.
25:00The easiest way is always to do a general anesthesia.
25:06Then you don't hear a peep from the patient and they can't move at all.
25:10And some surgeons see that as a kind of luxury that they appreciate.
25:13After just half an hour, the operation is complete and the wound is neatly stitched. An ideal outcome.
25:24The professional association hopes local anesthesia will become even more common in the future.
25:30Holger Detman feels great just minutes after the operation.
25:36It was completely painless, which was the most important thing for me.
25:40Everything went smoothly. Detman can go home.
25:45A quick return to daily life. Another benefit of local anesthesia.
25:53That's all for this edition of In Good Shape.
25:56See you next time and stay healthy.
26:10I'm gonna go.
26:12There is a couple of them.
26:13I'm gonna go.
26:14I'm gonna go.
26:15I'm gonna go.
26:16The first one that I'm gonna go to is just me.
26:21This one is a good one.
26:23I'm gonna go.
26:25One, two, one.
26:26One, two, three, four.
26:28I'm gonna go.
26:29I'm gonna go.
26:31Two, three, five, four, five, one, four, one.
26:35I'm gonna go.
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