Sleep Hygiene/Dissenting Opinion

[mollete]

You Molette are quite clueless ...

2 "l"s, one "t", small "m" please.

[mollete]

But I am not going to waste any time convincing you this situation exists because in my opinion, your mind is already made up. I was stupid to think I could enlighten you but I should have known better based on your previous posts.

But don't you feel MUCH better now, having someone else to blame?

You're welcome!

[mollete]

You Molette are quite clueless about what patients with past and current psych histories face in dealing with doctors.

And here is where you are so clueless about my cluelessness.

If a patient walks into a (for the sake of argument, "sleep") professional's office and says "Hey, I'm on Lexapro, Effexor, Wellbutrin, Prozac and Ambien", the "sleep professional" does not say, "Wow, look at all the crap this nut found on eBay to self-treat", they say, "Wow, look at all the crap (actually they say "polypharmacy") that some FnAH prescribed that obviously knows nothing about how sleep works".

[Drowsy Dancer]

Many of us who have been on psych meds have decided not to disclose our history because we feel it leads to horrific care as we immediately get pegged with an MI label and all our other concerns are completely discounted.

...people may hold back critical bits of information (like they're a coke fiend or meth head) that may have great bearing in determining causative factors of sleep disorders...

and consequently any treatment approach may be doomed.

I don't know if that thought process is a fear of failure of fear of success, but it's obviously way over my pay grade.

Yet, it may be academic. Harmful medication side effects (which is all we really need to know anyway, cause if there's no problem, there's no fixing necessary) may be disclosed when looking at the sleep architecture "fingerprint" (which may exhibit delayed/reduced/absent REM, excessive stage shifts, WASO or NREM1 and unexplained ("spontaneous") arousals.

I wonder.

What then is the effect on the doctor-patient relationship when the sleep architecture fingerprint reveals the side effects of medications that a patient has failed to disclose, or even affirmatively denies taking?

In my line of work, it's the information that clients withhold from me that makes me approach them with greater skepticism (not pegging them with any label or providing them with horrendous service, mind you), and not the information they reveal. I can work with just about any set of facts once I know what the facts actually are.

[49er]

Many of us who have been on psych meds have decided not to disclose our history because we feel it leads to horrific care as we immediately get pegged with an MI label and all our other concerns are completely discounted.

...people may hold back critical bits of information (like they're a coke fiend or meth head) that may have great bearing in determining causative factors of sleep disorders...

and consequently any treatment approach may be doomed.

I don't know if that thought process is a fear of failure of fear of success, but it's obviously way over my pay grade.

Yet, it may be academic. Harmful medication side effects (which is all we really need to know anyway, cause if there's no problem, there's no fixing necessary) may be disclosed when looking at the sleep architecture "fingerprint" (which may exhibit delayed/reduced/absent REM, excessive stage shifts, WASO or NREM1 and unexplained ("spontaneous") arousals.

I wonder.

What then is the effect on the doctor-patient relationship when the sleep architecture fingerprint reveals the side effects of medications that a patient has failed to disclose, or even affirmatively denies taking?

In my line of work, it's the information that clients withhold from me that makes me approach them with greater skepticism (not pegging them with any label or providing them with horrendous service, mind you), and not the information they reveal. I can work with just about any set of facts once I know what the facts actually are.

Drowsy Dancer,

I understand your position but again, what about my concern that disclosing past and current psych med histories leads to bad treatment? This is not an isolated incident by the way as this subject is a common topic on psych med withdrawal boards.

One person who has suffered horrific insomnia from being on antipsychotics describes even worse experiences than mine when she disclosed her history. She said when she didn't, her treatment improved.

Maybe you and Mollette don't discriminate against people with psych med histories but to blame us for withholding information when there is outright discrimination seems very unfair to me.

49er

PS - I just found this article you might be interested in that I feel supports my position:

http://www.huffingtonpost.ca/marvin-ros ... _ref=false

[pikov22]

I would respectfully submit that if someone is waking up to an alarm every day that they are not practicing good sleep hygiene, as that would certainly suggest they are building a sleep deficit.

I would like to see her reference on the "expert" who told her that. "IMHO", a blaring alarm in the middle of Final REM is a great way to pretty much guarantee that you'll be in a state of high anxiety for at least a couple hours.

Simply, it sounds like this person's bedtime is too late.

I would suspect that what the expert suggested was going to bed a little earlier each night and getting up a little earlier each morning. That way, a person's sleep time could theoretically be shifted to match normal diurnal rhythm.

[SleepingUgly]

If a patient is on psychotropics, a sleep doctor should consider (1) the effect on sleep of the psychotropics and (2) the effect on sleep of the disorder for which the meds were prescribed. IDEALLY, the very competent doctor who knows about both sleep and mental illness would consider the possibility that a subset of these patients have either been misdiagnosed, or that their mental health issue is actually a consequence of their untreated/ill-treated sleep disorder, or that the two issues are exacerbating each other, or that the meds are exacerbating one or the other disorder, etc.

But I agree that so many doctors (especially sleep doctors) are not competent or knowledgeable enough to even approach what they "ideally" should be doing, or to even recognize their own biases. I think it's very easy for a doctor to chalk something up to mental issues than to try to unravel a complicated problem with multi-facets, including possibly iatrogenic symptoms. Many without significant mental health issues or psychotropic meds on board seem too complicated for the average sleep doc.

IDEALLY, a patient who is on psychotropics would be best served by going to a psychiatrist who is boarded in sleep. But there aren't many relative to the number of pulmonologists, neurologists, and even ENTs who are boarded in sleep. It's unfortunate.

[kteague]

Being gun-shy about revealing possible prejudicial information is understandable. Before my OSA and PLMD diagnoses I had at least 3 doctors push me toward admitting I was depressed. I remember adamantly insisting, "I'm not depressed, I'm sick. Find out what's wrong with me and I'll be fine." I've thought in the past how much I'd like to go to a new doctor and start with a clean slate and see what fresh eyes could discover. The problem with that is I would feel like I was asking them to do their job with their hands tied behind their back. The ideal relationship between patients and their medical professionals can be elusive. Let's cut each other some slack for seeing things from their own perspective.

[jnk]

And docs can disagree with one another on certain complicated medical matters and are taught to defer to the expertise of their fellow docs in some situations instead of taking full control and cancelling prescriptions other docs have made.

I don't think it is always a matter of a doc refusing to treat someone with a history of other illnesses and other meds. It is more often, in my opinion, a matter of the sub-specialist understanding that he is not the overriding coordinating medical professional for the person sitting in front of him.

It is true that the psych doc, or primary doc, may not grasp the damage done to sleep by some meds, but it is equally true that the sleep doc may have no way of knowing how damaging to the patient it would be to make a vocal case for stepping a patient down off those meds. Who makes the call? Especially when there are conflicting opinoins between specialists? It requires some coordination on the part of the lead doc who has been sending his patient to mulitple specialists, and that lead doc may not have the experience or education (or, frankly, time) to coordinate such matters with any more insight than the patient himself has. So it sadly falls to the patient to be educated and proactive and decisive without trying to divide and conquer his own medical team.

I am not proposing a solution to the stalemate someone in that position finds himself in. My point is only that the situation may be more complicated than the perceived prejudice against patients on head meds. It may be more a prejudice against the complications of conflicting goals as taught by separate disciplines of medical treatment. And I can understand why, to a patient, that may be a distinction without a difference, in practice.

I realize that the discussion is about people previously on so-called anti-depression meds, but I think the principles come into play in much the same way.

[chunkyfrog]

My sleep doc noted that I have GERD (I don't think I do)
based solely on the acid blocker I take due to excess acid as a result of having no gall bladder.
I need to call my PCP and see if he agrees.

[Drowsy Dancer]

Drowsy Dancer,

I understand your position but again, what about my concern that disclosing past and current psych med histories leads to bad treatment? This is not an isolated incident by the way as this subject is a common topic on psych med withdrawal boards.

One person who has suffered horrific insomnia from being on antipsychotics describes even worse experiences than mine when she disclosed her history. She said when she didn't, her treatment improved.

Maybe you and Mollette don't discriminate against people with psych med histories but to blame us for withholding information when there is outright discrimination seems very unfair to me.

49er

PS - I just found this article you might be interested in that I feel supports my position:

http://www.huffingtonpost.ca/marvin-ros ... _ref=false

I can't comment on your concern because it is your concern, and I'm not trying to disrespect your perception, nor ascribe "blame" as such. One potential problem I see with your strategy of withholding information because you believe discrimination if the information is revealed to follow as a certainty. I admit that it's a possibility, but my (somewhat philosophical) response to that is that, if you reveal information to a care provider who then maltreats you, dump that care provider (which I believe you have done in the past).

Not everyone with a psych med history, of course, has the option to change up care providers, which is why this issue is so delicate.

I take a somewhat radical view and believe that this kind of history should be destigmatized (easy for me to say with my psych history consisting only of GAD and ADD). I believe that honesty is always the best long run policy.

Let me tell you a story the outcome of which has informed by thinking greatly over the years.

I have a very close relative who is a health care provider.

In the 1980s, she went through a very tough time in her life, including a devastating divorce.

She began taking anti-depressants.

She had a doctor friend prescribe them for her on the side, or give her samples, or something (the details weren't clear), because she said if she disclosed taking the anti-depressants, she would be considered an impaired provider and either her malpractice rates would go way up or she wouldn't be able get coverage (her reasoning seems to be similar--she was concerned about discrimination).

What I told her at the time was that I didn't think it was a good idea to self-treat like that, and that I wasn't going to turn her in to any authority, but if anyone ever asked me point blank under oath and I was compelled to testify (which I would try to avoid), I would not lie for her.

Her depression, by my observation, did not clear up. Her self-treatment, um, escalated from anti-depressants to painkillers and alcohol (I knew about the alcohol but not the painkillers). In the late 1990s she was caught swiping something at work, spent months in inpatient rehab, and was subject to random UAs and weekly therapy for five years as a condition of keeping her license. She experienced incredible suffering and shame.

My belief is that, had she been candid with her treatment provider(s) about her difficulties from the mid-1980s on, she wouldn't have needed to walk all the way down the path that she did, because someone with more objectivity than she could bring to herself could have helped her over the fifteen or so years she spent not getting treatment.

I certainly cannot claim that I foresaw this specific outcome from her concealment of her own history/problems. My conclusion, however, was that the longer such a secret is kept the worse it seems to go for the person with the secret, and I err on the side of overdisclosure to my own providers.

My n=1.

[Todzo]

You Molette are quite clueless

Hi 49er!

I do not think he she they are clueless. I think they are dedicated (and perhaps paid) to frustrate valid conversation here.

When I saw your title I knew your thread would be trashed by trolls. And so it is.

Have a great week anyway!

Todzo

[blueh2o]

Hi Blue,

Do you lay in bed when you wake up and can't fall back asleep? I have to get up or lying there will drive me crazy.

I am looking for the magic bullet also. I guess all of us who are struggling are.

49er,
My problem is a little different. I don't have much of a problem getting to sleep at any given time. I just can't stay asleep. I wake up between 8-20 times a night. It might only be for 5-10 minutes at a time but seriously screws up my sleep architecture to the point where I can't really tell the difference between being asleep or being awake. In other words, I'm stuck in Stage 1 or 2 sleep all night with little REM and NO delta sleep, period. Saw the ortho yesterday for the TAP and he's out of ideas for me to. I'm going to get another PSG just to officially record how the TAP works for the AHI. Otherwise, what next??? xPAP failed, oral appliance failed, CBT failed. I know there's many of us out there.
I'm somewhat convinced that, for me, the problem is some intertwined combination of psychological and physiological and I can't solve one without the other. I'm somewhat concerned that I'm going to have to wait for the medical community and/or technology to catch up with people like me/us.

[Sir NoddinOff]

I'm somewhat convinced that, for me, the problem is some intertwined combination of psychological and physiological and I can't solve one without the other. I'm somewhat concerned that I'm going to have to wait for the medical community and/or technology to catch up with people like me/us.

I know the feeling. I have my good nights and bad nights, but when things get rough I feel like I'm way out on the cutting edge of medical technology and waiting for science to catch up with me. My sleep hygiene is decent, my CPAP solves my snoring, my bedtime schedules are okay, my exercise and diet issues are okay... however there's something happening between my brain, pulmonary, blood chemistry, glandular systems that's going awry. I've tried to read medical papers on the various bio-feedback loops but it's so byzantine I can't even imagine doctors grasping it. I suspect these are early days in sleep discovery. If I could pay ten thousand dollars for a switch installed in the back of my head, which when flipped, would shut me down every night into a sound sleep - I'd shell out the bucks in a minute and never look back .

[ems]

I'm somewhat convinced that, for me, the problem is some intertwined combination of psychological and physiological and I can't solve one without the other. I'm somewhat concerned that I'm going to have to wait for the medical community and/or technology to catch up with people like me/us.

If I could pay ten thousand dollars for a switch installed in the back of my head, which when flipped, would shut me down every night into a sound sleep - I'd shell out the bucks in a minute and never look back .

I'll bet this holds true for many of us.

How lovely it would be to be a kid again and just hop into bed and go right to sleep.