Sleep Dynamic Therapy

Archive for the ‘Depression’ Category

Forty-eight comments were posted on the recent New York Times article on treatment of chronic nightmares. Reading them was illuminating and encouraging, because the overwhelming majority of writers showed a great deal of common sense in their appreciation for the use of imagery rehearsal therapy (IRT). Among this group, there were numerous stories of those who had received similar instructions from a parent or friend who advised them to “change” something about their nightmare scenarios. In other words, these people or their children had lived through a process of suffering from nightmares and then successfully eradicated them through an instruction that afforded them a measure of influence over the problem. Read the rest of this entry »

Dr. Barry Krakow discusses how medical errors occur due to sleepiness and fatigue of doctors and caregivers. Read the rest of this entry »

An excellent article summarizing a number of links between sleep disturbances and mental illness, but it lacks a lot of details about the sleep breathing connections.

Since the publication of my book, Sound Sleep, Sound Mind, I continue to monitor reports from sleep patients who come to clinic using antidepressant medication for a variety of reasons.

Some take these drugs to relieve a “sleep disturbance,” treat a “stressed out” life, manage clinical depression, or for no clearcut reason according to the patient.

When I ask these patients what exactly antidepressants achieve for them, the following are the most typical replies:

1. Decrease in irritability
2. Decrease in emotional outbursts
3. Decrease in anxiety or depression symptoms.

Few of these patients ever state the following:

1. Elimination of anxiety or depression
2. Elimination of a sleep disturbance
3. Markedly improved emotional coping.

Instead, the typical patient I see in a sleep clinic, while reporting some benefits from antidepressants, often wonders what they are treating beyond high stress levels, almost always states that the pills “numb” their emotions instead of fixing anything, and frequently wonder whether their depression is a direct result of loss of sleep or poor sleep quality.

What continues to confuse and bother me is that there tends to be this general consensus that a low threshold for prescribing antidepressants becomes the commonly accepted approach to poor coping, as if poor coping is code for depression and therefore antidepressants are a reasonable option.

My biggest complaint about this perspective from a sleep medicine vantage point is that poor coping could just as easily be due to fatigue and sleepiness from a sleep disorder, in which case antidepressant treatment is inappropriate whereas diagnosing and treating the sleep disorder is the appropriate treatment.

However, an even more fundamental complaint is the very acceptance of poor coping as a diagnosable condition requiring a pharmacological treatment. Poor coping in my clinical experience usually is a sign of weak emotional processing skills. If you give the patient a few sessions built around the premise that identifying underlying emotional reactions yields a lot of insight that leads to improved coping, then I think many prescription pads would be unused.

Human emotion is a natural part of our makeup, and almost anyone can learn to improve some of their coping skills by learning to recognize and work through some of their emotional reactions instead of just labeling them stress and seeking a new pill to wash away the feelings.

This study on changes in depression following CPAP use is very important, because it looks at the longer term impact of treating SDB. In some other recent studies, the time frame was too short to learn much about what PAP therapy does to depression. Remember, most depression builds in patients over many months time, if not longer. To reverse depression or at least reduce it, we would expect a sleep-oriented treatment to take several weeks or months to have a meaningful impact. That’s what these researchers found.