OT? NYT: Sleep therapy seen as aid for treating depression

[robysue]

I know a lot of folks around here are struggling with both insomnia and depression. There's an interesting article on the front page of today's NYT about the connections between the two and using CBT-I as part of a multi-targeted approach to treating depression. Two interesting tidbits:

There's an acknowledgement that in many cases, the insomnia probably predates the depression rather than being caused by the depression.

CBT-I is not just "teach 'em about good sleep hygiene."

The full article is available on line at: http://www.nytimes.com/2013/11/19/healt ... .html?_r=0

[jnk]

Thanks!

Amen to Dr. Krystal's statement quoted at the end of the article:

“Our [psychiatric] treatments are driven by convenience. We treat during the day and make little effort to find out what’s happening at night.”

Improving sleep never makes brain problems worse. A sleep study should be step one before any psychiatric diagnosis, in my not-so-humble opinion.

[49er]

I know a lot of folks around here are struggling with both insomnia and depression. There's an interesting article on the front page of today's NYT about the connections between the two and using CBT-I as part of a multi-targeted approach to treating depression. Two interesting tidbits:

There's an acknowledgement that in many cases, the insomnia probably predates the depression rather than being caused by the depression.

CBT-I is not just "teach 'em about good sleep hygiene."

The full article is available on line at: http://www.nytimes.com/2013/11/19/healt ... .html?_r=0

Saw it and commented that I was disappointed that no mention was made about undiagnosed sleep apnea causing depression. Several other commentators said the same thing.

They also ignored the fact that many antidepressants can cause insomnia. So if that is what someone is dealing with, then giving CBT-I to someone wouldn't obviously be very effective.

49er

49er

[49er]

Thanks!

Amen to Dr. Krystal's statement quoted at the end of the article:

“Our [psychiatric] treatments are driven by convenience. We treat during the day and make little effort to find out what’s happening at night.”

Improving sleep never makes brain problems worse. A sleep study should be step one before any psychiatric diagnosis, in my not-so-humble opinion.

Amen JNK.

As one who feels I wasted 15 years of life on psych meds that was due to undiagnosed apnea, I couldn't agree more that a sleep study should be done before any psych diagnosis. When I was put on the meds, medical professionals weren't aware of apnea so I can't blame them for what happened. But it is no longer excusable to stop this step in my opinion.

49er

[jnk]

It is difficult because it appears that there ARE some brain troubles that result in bad sleep. But I believe it to be MUCH more common that bad sleep leads to brain troubles.

Sleep is one of the most observable functions of the brain, so it seems to me that sleep would be the best place to start investigations of better ways to diagnose the organ.

Sleep medicine is in its infancy. And if things don't change, its growth will be stunted from monetary malnutrition.

[Todzo]

For the past month I have been finding that exercise is effective for me to keep insomnia away. What I am now doing and have done for the last month or so is to increase my low level and aerobic exercise pretty much daily to the point of fatigue. In my case that is between 2-3 hours a day. I mix this with thrice weekly resistance training.

I am off the drugs and enjoying life better without them.

Compliments of another researcher:

There are multiple meta-analyses and studies [1-12] examining the literally thousands of studies regarding whether exercise is as effective a treatment as drugs, evidence-based psychotherapies, or both. All of these meta analyses conclude that exercise is as effective on its own as drugs and psychotherapy. Based on the fact that psychotherapeutic drugs are known to negatively alter a patient's brain shape and metabolism, while exercise has been evidenced to do the exact opposite, it appears that this is now an ethical issue. How can it be ethical to encourage drug prescription when another treatment is known to be as effective, without the side-effects on metabolism and brain shape?

[1] Russell-Mayhew, S., McVey, G., Bardick, A., & Ireland, A. (January 01, 2012). Mental
health, wellness, and childhood overweight/obesity. Journal of Obesity, 2012.
[2]  Stathopoulou, G., Powers, M. B., Berry, A. C., Smits, J. A. J., & Otto, M. W. (May 01,
2006). Exercise Interventions for Mental  Health: A Quantitative and Qualitative
Review.Clinical Psychology: Science and Practice, 13, 2, 179-193.
[3] Fremont, J., & Craighead, L. W. (April 01, 1987). Aerobic exercise and cognitive
therapy in the treatment of dysphoric moods. Cognitive Therapy and Research, 11,
2, 241-251
[4] Broocks, A., Bandelow, B., Pekrun, G., George, A., Meyer, T., Bartmann, U.,
Hillmer-vogel, U., ... R�ther, E. (May 01, 1998). Comparison of aerobic exercise,
clomipramine, and placebo in the treatment of panic disorder. American Journal of Psychiatry, 155, 5.)
[5]   Doyne, E. J., Ossip-Klein, D. J., & Bowman, E. D. (October 01, 1987). Running versus
weight lifting in the treatment of depression. Journal of Consulting and Clinical
Psychology, 55, 748-54.
[6] Veale, D., Le, F. K., Pantelis, C., de, S. V., Mann, A., & Sargeant, A. (January 01, 1992).
Aerobic exercise in the adjunctive treatment of depression: a randomized controlled
trial. Journal of the Royal Society of Medicine, 85, 9, 541-4.
[7] Richardson, C. R., Faulkner, G., McDevitt, J., Skrinar, G. S., Hutchinson, D. S., & Piette,
J. D. (January 01, 2005). Integrating physical activity into mental health services for
persons with serious mental illness. Psychiatric Services (washington, D.c.), 56, 3,
324-31.
[8] Dishman, R. K., & Buckworth, J. (January 01, 1996). Increasing physical activity: a
quantitative synthesis. Medicine and Science in Sports and Exercise, 28, 6,
706-19.
[9] Slootmaker, S. M., Chinapaw, M. J. M., Schuit, A. J., Seidell, J. C., & Van, M. W. (July
29, 2009). Feasibility and Effectiveness of Online Physical Activity Advice Based on
a Personal Activity Monitor: Randomized Controlled Trial. Journal of Medical Internet Research, 11, 3.)
[10] Burton, N. W., Pakenham, K. I., & Brown, W. J. (January 01, 2010). Are psychologists
willing and able to promote physical activity as part of psychological
treatment?.International Journal of Behavioral Medicine, 17, 4, 287-97.
[11] Perraton, L. G., Kumar, S., & Machotka, Z. (June 01, 2010). Exercise parameters in the
treatment of clinical depression: a systematic review of randomized controlled   
trials.Journal of Evaluation in Clinical Practice, 16, 3, 597-604.
[12] Rethorst, C. D., & Trivedi, M. H. (January 01, 2013). Evidence-based
recommendations for the prescription of exercise for major depressive disorder.
Journal of Psychiatric Practice, 19, 3, 204-12.

[Lazer1234]

As one who feels I wasted 15 years of life on psych meds that was due to undiagnosed apnea, I couldn't agree more that a sleep study should be done before any psych diagnosis. When I was put on the meds, medical professionals weren't aware of apnea so I can't blame them for what happened. But it is no longer excusable to stop this step in my opinion.

49er

Would you like to develop your reasoning more about your diagnosis and your sleep disorder? Or if you'd prefer to via a PM?
My wife has some problems and also with sleep, difficulty falling asleep and poor sleep. 1 year wait to get to do a sleep study, so I bought a apap PR 560 to her by STL Mark. We have now made ​​the first night with it and I'll try to titrate as best I can.
It would be interesting to hear your theories about this with psych diagnosis and sleep disorders

[chunkyfrog]

I was "diagnosed" with SAD after my faked negative sleep study.
edit: 19 years ago, cpap was probably too expensive for my HMO.

[Todzo]

I was "diagnosed" with SAD after my faked negative sleep study.
edit: 19 years ago, cpap was probably too expensive for my HMO.

1985 all they did was put a heart monitor on me for three days, read it, and pronounce me apnea free.

I think I am glad the science and technology has improved. I think that whatever I may have had "way back then" become worse and worse over the years so when they tested me with a full PSG in 2003 - yup severe OSA with extreme hypoxia!!!

I am suspicious that OSA often has false negatives simply because the OSA was not present that particular night. I know from my own data that I sleep differant every night and I know that inflammation, muscle tension, stress, and many other physiological factors are differant every day. I think we should do the testing in the home over many days.

So perhaps it was more a combination of science not as developed, your disease not as developed, and a bit of bad luck that led to the false negative sleep test way back then.

[49er]

Thanks for asking. Sent you a PM.

As one who feels I wasted 15 years of life on psych meds that was due to undiagnosed apnea, I couldn't agree more that a sleep study should be done before any psych diagnosis. When I was put on the meds, medical professionals weren't aware of apnea so I can't blame them for what happened. But it is no longer excusable to stop this step in my opinion.

49er

Would you like to develop your reasoning more about your diagnosis and your sleep disorder? Or if you'd prefer to via a PM?
My wife has some problems and also with sleep, difficulty falling asleep and poor sleep. 1 year wait to get to do a sleep study, so I bought a apap PR 560 to her by STL Mark. We have now made ​​the first night with it and I'll try to titrate as best I can.
It would be interesting to hear your theories about this with psych diagnosis and sleep disorders

[steveinmaine]

Thanks for the article and comments. I saw a sleep doctor for the first time this month, and that gives me hope of feeling better soon.

And Todzo, thought you'd appreciate this quote I saved some years ago.

The way I deal with my depression now is physical activity. I’m not saying I’m free of all my problems, but I find that really pumping your body out, exhausting yourself, doing some exercise regularly, must bring all of your system into some kind of alignment. I think a jump rope can be as helpful to a depression as two years on methadone maintenance or five years in psychotherapy.
– James Taylor

[Todzo]

Thanks for the article and comments. I saw a sleep doctor for the first time this month, and that gives me hope of feeling better soon.

And Todzo, thought you'd appreciate this quote I saved some years ago.

The way I deal with my depression now is physical activity. I’m not saying I’m free of all my problems, but I find that really pumping your body out, exhausting yourself, doing some exercise regularly, must bring all of your system into some kind of alignment. I think a jump rope can be as helpful to a depression as two years on methadone maintenance or five years in psychotherapy.
– James Taylor

I really do believe that all those assigned CPAP should also be assigned a dietitan and personal trainer for at least three years.

Yes it is nice to have a splint to try to get rid of some of the apnea. But the machine tends one toward unstable breathing (which the exercise may well lessen) and getting rid of the metabolic imbalance and nutritional deficiently which likely brings about OSA likely moves the body away from the illness and toward a true cure.

[49er]

Thanks for the article and comments. I saw a sleep doctor for the first time this month, and that gives me hope of feeling better soon.

And Todzo, thought you'd appreciate this quote I saved some years ago.

The way I deal with my depression now is physical activity. I’m not saying I’m free of all my problems, but I find that really pumping your body out, exhausting yourself, doing some exercise regularly, must bring all of your system into some kind of alignment. I think a jump rope can be as helpful to a depression as two years on methadone maintenance or five years in psychotherapy.
– James Taylor

I really do believe that all those assigned CPAP should also be assigned a dietitan and personal trainer for at least three years.

Yes it is nice to have a splint to try to get rid of some of the apnea. But the machine tends one toward unstable breathing (which the exercise may well lessen) and getting rid of the metabolic imbalance and nutritional deficiently which likely brings about OSA likely moves the body away from the illness and toward a true cure.

Two different issues.

There is no doubt that exercise can definitely relieve depression although like with any treatment, your mileage will vary. However, as to whether it relieves insomnia is still debatable in my opinion. There was a recent study that showed that for folks in which exercise helped insomnia, they had to do it for about 3 months before they obtained any benefit. When you're already tired and exhausted, that would be kind of demoralizing in my opinion to have to wait that long. But then again, it might be worth it to folks, particularly if they were tired of taking meds and or found them not to be helpful.

There is no evidence that apnea can be cured with nutrition or is due to diabetes. Of course, taking care of those issues can only help but to imply that they cure apnea is really dangerous advice in my opinion. Heck, even alternative health folks aren't making that claim.

SteveinMaine, many years ago, there was an article about a local therapist who talked to her clients when they were on the treadmill. I found it fascinating and wondered why more mental health professionals didn't do that.

49er

[robysue]

I really do believe that all those assigned CPAP should also be assigned a dietitan and personal trainer for at least three years.

And just who the heck would pay for all this?????

The average new PAPer isn't even lucky enough to get a full efficacy data machine---even when a full data costs no more than $100 or $200 retail than the brick the typical PAPer is set up with by the DME.

The average new PAPer isn't even lucky enough to get any meaningful hands on training on how to use the PAP, read the data, and understand the data the machine collects.

Heck, the average new PAPer usually doesn't receive any meaningful education about OSA at all from the health care system---just a quick appointment with a sleep doc who doesn't take the time to explain any of the numbers on the PSG or the differences between a hypopnea and an apnea or which way the hypopneas were scored and why that matters. No, the average new PAPer is simply told, "You stop breathing $n$ times per hour and you need to use this machine every night for the rest of your life," and then is given a brick and shown the on/off button and told "Tighten the straps if you feel any leaks." Really it's no surprise that 50%+ of new PAPers don't make it, given the lack of meaningful support from the sleep medicine community, the DMEs who sell us the overpriced equipment, and our insurance companies with their oftentimes byzantine requirements for testing and obscure replacement schedules and reimbursement policies ...

Yes it is nice to have a splint to try to get rid of some of the apnea.

A well-tuned PAP machine doesn't "get rid of some of the apnea." Once therapy is optimized, the machine gets rid of all or virtually all of the apnea. As in the person sleeping with the CPAP has no more sleep disordered breathing problems than a normal person has when the normal person is sleeping well.

But the machine tends one toward unstable breathing (which the exercise may well lessen) and getting rid of the metabolic imbalance and nutritional deficiently which likely brings about OSA likely moves the body away from the illness and toward a true cure.

Like 49er points out, there's no real scientific evidence that backs up your theory that a nutritional deficiency somehow causes the OSA. For the folks who have a metabolic imbalance that leads to OSA, the metabolic imbalance is overeating which leads to weight gain. But even there, there's as much evidence that for a large number of overweight PAPers, the OSA came first and changed the metabolism rather than the other way round.

And quite frankly, I think you vastly overestimate the tendency of a CPAP to encourage what you regard as "unstable breathing" and I also think you over think the significance of the breathing patterns that you believe indicate "unstable breathing" patterns amongst PAPers.

[Foggy1]

I appreciate the link to the article. Very interesting.

This aligns with a book that I read last month called The Depression Cure, by Stephen Ilardi. Dr. Ilardi offers up six steps one can take to improve their depression without medication. One of them is healthy sleep. From the book: "Disrupted sleep is one of the most potent triggers of depression, and there's evidence that most episodes of mood disorder are preceded by at least several weeks of subpar slumber."

I believe it! Since my AHI has improved and my sleep has improved, I feel so much better. I was diagnosed with fibromyalgia two years ago. Since I'm sleeping better, I haven't been noticing the symptoms at all. I am beginning to question whether I actually have fibro, or was suffering from severe sleep deprivation. We'll see...weather changes tend to trigger my fibro flares and we've got some weather due this weekend.

49er commented that some antidepressants cause insomnia. I can sure attest to that. The doctor prescribed Cymbalta for my fibro pain, and advised me to take it at bedtime. Cymbalta is also used to treat depression. As soon as I began taking it I began having serious trouble falling asleep. When I switched to taking the Cymbalta in the morning, my insomnia completely went away.