Sleep Dynamic Therapy

Archive for the ‘Insomnia’ Category

Everyone’s talking about Stimulus these days and whether or not it will work.

In sleep medicine, we have a treatment technique known as Stimulus Control, which refers to the specific plan of not going to bed until you’re sleepy. In other words the way to avoid insomnia is to stay away from the bedroom until you feel genuine sleepiness that will put you fast asleep.

On a lighter side, I wonder whether we need a little Stimulus “Control” in our government. The government imagines that more stimulus will restore the economy, but that’s like telling an insomniac, spend more time in bed and you’ll get more sleep, which actually causes more insomnia. In this case, spending more money is guaranteed to stimulate our debt and deficit, but I think we’re all beginning to wonder just how good that is for the economy.

So, Mr.President, how about a little Stimulus “Control.”

My research team will be in Baltimore for the annual APSS, presenting 5 works from the past year, including:

1. Oral presentation by me on the topic of “Sleep Disordered Breathing in Patients Dependent on Prescription Sleep Medications.”
2. Oral presentation by Eddie Romero on the topic of “Nocturia as a Screening Tool for Sleep-Disordered Breathing.”
3. Poster by Linda Trujillo on the topic of “Self-Guided Imagery for Insomnia Patients undergoing Polysomnography Testing.”
4. Poster by Natalia McIver on the topic of “Self-Guided Imagery for SDB Patients undergoing a Polysomnography Titration.”
5. Poster by Eddie Romero on the topic of “Nocturia as a Screening Tool in Insomnia Patients with Potential Risk for Sleep-Disordered Breathing.”

One thing that continues to puzzle us in our work at our sleep center is how frequently patients are prescribed CPAP when we suspect they should have been initiated with bilevel therapy. We work on 2nd opinion patients quite a bit, and in nearly 90% of cases, the patient presents with a failed response to CPAP. Few if any of these patients ever report that their physicians discussed the potential to use bilevel instead of CPAP. Some had been exposed to auto-CPAP, Cflex, and other expiratory relief systems, but very few had even heard of the term bilevel.

In our clinical experience, where we specialize in mental health patients with insomnia and SDB, we quickly transition the patient to bilevel once they have failed CPAP therapy either initially during the desensitization procedure before the overnight titration or during the titration when it becomes apparent that they are struggling to breathe out against pressurized airflow coming in (expiratory intolerance).

Two weeks later, and I’ve yet to see one thoughtful discussion about what underlying sleep problems might have contributed to his insomnia and ultimately to his demise. On the one hand, the severe insomnia he appeared to suffer from as described in the tabloids would almost suggest bipolar or a manic-like experience. On the other hand, there is no discussion as to whether he was known to suffer any sleep breathing symptoms.

Tens of thousands of people take too many drugs to sleep at various times in their experiences with medications. The vast majority do not die! What distinguishes those who do not survive? The two most likely candidates are a breathing problem or a cardiac arrhythmia, the latter perhaps brought on by a breathing disorder that drops oxygenation to critically low levels.

The other questions that should have been asked are where did he get the pills, and did any of his prescribing physicians ever refer him to a sleep specialist?

Do you think someone should have taken Heath Ledger’s sleep complaints seriously? Based on the multiple drugs that allegedly caused his overdose, I doubt anyone took his sleep problems seriously!