Sleep Tests for Middle of the Night Insomniacs
Posted on April 30, 2007 by Dr. Krakow |In this recent letter to the editor in the Annals of Clinical Psychiatry, we respond to Dr. Rosenberg’s critique, which outlines some of the weaknesses in medications for the treatment of sleep maintenance insomnia (middle of the night awakenings). As we continue to find in our research and clinical work, most of these patients suffer awakenings due to sleep-disordered breathing. Therefore, testing these patients with overnight sleep studies in the sleep lab often yields valuable insights into the patient’s underlying sleep fragmentation and may lead to dramatic treatment gains, if the insomniac chooses to treat the sleep breathing condition.
Burden of Depression
Posted on April 12, 2007 by Dr. Krakow |Dr. Thomas Insel, Director of NIMH, makes a big splash on the burden of depression on disability, and rightly so. I look forward to the day when sleep disorders receive the same attention. More importantly, I want to see the time when the connections between depression and sleep disorders, particularly insomnia and sleep-disordered breathing, are made more rapidly to the benefit of those patients whose depression is largely caused by undiagnosed sleep disorders.
Dark Chocolate, Green Tea and Hypertension
Posted on April 10, 2007 by Dr. Krakow |The interesting question here is who would be more likely to eat dark chocolate, drink green tea, or suffer from hypertension? The answer is an individual with a sleep disorder and the most likely sleep disorder would be sleep-disordered breathing (SDB). SDB fragments your sleep by causing your brain to repeatedly wake up during repeated episodes of obstructed breathing, which you are not aware of because you are asleep at the time, and you tend to fall back asleep in seconds, so you don’t remember the awakening. This sleep fragmentation causes you to feel tired and sleepy during the day, which prompts many people to seek an energy boost in caffeinated products, such as dark chocolate and green tea. SDB-induced sleep fragmentation also has been linked to hypertension
The Limits of Psychiatry in Treating Psychiatric Insomnia
Posted on April 9, 2007 by Dr. Krakow |This talk was given in December 2003 at the University of New Mexico Dept of Psychiatry Grand Rounds. The title is the “Limits of Psychiatry in Treating Psychiatric Insomnia.” It reflects our growing interest in the relationships between sleep-disordered breathing and insomnia, particularly in mental health patients. Note the material on nocturia is dated and see Mary Umlauf’s work for a more comprehensive explanation for why sleep breathing patients wake up at night to use the bathroom. In short, the body is deceived into believing that a fluid overloaded state exists and so it must release a natural diuretic to “correct” the problem
How to categorize depression
Posted on April 9, 2007 by Dr. Krakow |The finding that depression symptoms are categorized too broadly has been well known in many clinical circles for a long time. Sleep doctors often see patients given antidepressants for periods of stress that really don’t match up with a diagnosis of depression. The patients themselves are often confused about why they received the prescription. Most importantly, at the end of the article is the commentary about patients’ misunderstandings about negative emotions, that is, do you take a pill to treat negative emotions or do you have something to learn from them? Sleep Dynamic Therapy, which uses sleep-related emotional processing techniques akin to Leslie Greenberg’s work in Toronto, finds that most insomnia patients benefit a great deal from working with their emotions, especially in comparison to what they gain by using sedatives or other medications.
