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

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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49er
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Re: OT? NYT: Sleep therapy seen as aid for treating depression

Post by 49er » Tue Dec 10, 2013 2:08 am

There have been numerous studies that have shown that when you put most insomniacs in a sleep lab, they have a much, much harder time accurately telling when they are asleep from when they are awake as compared to non-isomniacs. One study that I remember reading about had the investigators waking the subjects up at random and asking "Were you awake before I woke you?". Insomniacs typically answered, "Yes" regardless of the EEG evidence concerning the wake/sleep status before the wake was initiated; noninsomniacs typically answered the quesition correctly saying "No" when the EEG said they were asleep and "Yes" when they were awake. On questionaires following PSGs, insomniacs typically vastly OVER estimate the amount of Wake After Sleep (as compared to the EEG data) and UNDER estimate the actual sleep they get in the lab. Noninsomniacs are usually much more accurate in their estimates of sleep time.
Hi RobySue,

As an FYI, this site is inferring that the percentage of folks who underestimate how long they slept is 5%.

http://www.psychologytoday.com/blog/sle ... l-insomnia
Paradoxical insomnia is found in only about 5 percent of patients who present for treatment of insomnia
This study says it is is 17%

http://www.apapracticecentral.org/updat ... bance.aspx
An unusually high number of individuals (17 percent) had paradoxical insomnia (the subjective perception of little or no sleep, despite a normal sleep duration) as compared to the civilian population. Additionally, individuals with sleep disorders were more likely to be diagnosed with depression and anxiety than their non-sleep disordered counterparts. Lastly, those individuals with pain syndromes were more likely to have insomnia.
Regarding the studies you mentioned, could it be that both parties are right in that someone could be between a state of wakefulness and sleep where they might remember being awoken even though the EEG says they are asleep? Also, if you're awakened repeatedly, due to the constant disruptions on an already sleep deprived state, it is going to be hard to be able to accurately remember how much they slept.

To be honest, since the medical community has a history of minimizing the complaints of people with insomnia, I am very leery of any claims that everyone with this designation under report how much sleep they get. Also, I am not sure I understand why this is such an emphasis in sleep medicine.

I can understand it if someone is sleeping 6 hours and they are claiming they sleep 2. But for most people with insomnia, they are only sleeping 3 to 4 hours a night and sometimes even less. So really, does it matter if they might be inaccurate in their reporting? It isn't like getting an extra hour is going to make a difference in their sleep usually.

I also find it interesting that people who overestimate how well they sleep aren't deemed as having a sleep mis-perception. It is like people who complain about insomnia are unintentionally deemed as whiners and or complainers.

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

Post by 49er » Tue Dec 10, 2013 4:43 am

kteague wrote:In my limited experience, it seems psychiatrists these days are not as single focused on meds as 25 years ago. Seemed there was an unparalleled era of oversedation then. But even then, I wonder if it was just that the bad ones garner all the attention. Maybe there were many ethical ones even then who treated the whole patient, but those patients' lives went forward so successfully that no one even suspected they were under psychiatric care. I have a friend who is a psychiatrist, and I've found her to be an independent thinker, so no matter what was thrown at her in her training, she has sorted through it all to reach her own conclusions. In any occupations, there are good and bad performers.
Hi kteague,

Actually polypharmacy abuse has gotten alot worse in my opinion and this blog entry by a psychiatrist seems to support that view:

http://davidmallenmd.blogspot.com/searc ... lypharmacy
A study of antidepressant and antipsychotic treatment effects showed there is an emphasis on "polypharmacy" in clinical practice, without much evidence of benefit and an increase in adverse effects. Swiss investigators reported these findings at the 23rd European College of Neuropsychopharmacology Congress (23rd European College of Neuropsychopharmacology (ECNP) Congress: Abstract P.2.c.019. Presented August 31, 2010).

"In our study, we found no advantages for 'complex' treatment approaches over conventional monotherapeutic approaches," said senior investigator Hans H. Stassen, PhD, of University Hospital of Psychiatry in Zurich, Switzerland. "There appear to be no controlled studies showing the superiority of combinations of drugs over [a single drug (monotherapy)]. We looked at this because we have observed in clinical practice that response rates are less and side effects are greater." (reported by Medscape).

Treatment with antidepressants and antipsychotics was often non-specific in a number of ways, according to the study authors. Yet polypharmaceutical approaches have gained favor in recent years. Today' treatment regimens rely on various combinations of antidepressants, antipsychotics, mood stabilizers, anxiolytics, hypnotics, analgesics, and antiparkinson drugs.
I do agree with you that stereotyping all professionals as bad or good is not productive and that there are some forward thinking psychiatrists. Additionally, going to someone who is an alternative psychiatrist may be quite dangerous. I know someone who was almost killed by one and ironically had to go to a conventional person to get meds needed to prevent severe withdrawal symptoms.

Finally, I think if psychiatrists took the approach discussed in this article in being honest about the benefits and risks of meds, they would have a much better reputation in my opinion.

http://www.huffingtonpost.com/bruce-e-l ... 33424.html

Instead, many of them take the approach that meds are for life and when patients want to get off of them, are not very helpful generally. That simply isn't right and needs to change.

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

Post by jnk » Tue Dec 10, 2013 7:58 am

I think docs go to school mostly to learn how to traffic in three things--diagnostics, drugs, and suggestions for nonmed approaches. For a mind doc, that means they discuss (there isn't much else they can do to diagnose or measure response), they prescribe, or they make suggestions for different ways of thinking about things. If a mind doc doesn't prescribe, he gets condemned as someone who blames everything on the patient's views; if a doc does prescibe in the way medical school taught him to do, he gets labeled a drug pusher. If a mind doc does both, he gets hated by everyone for taking both sides of the issue. But I agree that as a general rule, you go to a mind doc to get meds or get suggestions. But when a mind doc is also a sleep doc, the doc becomes a better mind doc AND a particularly valuable sleep doc for those dealing with mind/brain issues at the same time. In my opinon. Quality of sleep is very much related to mind states and thought processes, even for those of us diagnosed with something as purely physical as upper airway obstructions during sleep.

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

Post by Loreena » Tue Dec 10, 2013 8:57 am

SuddenlyWornOut45 wrote:With proper pressures, minimal leak rates. Everything has to be close to perfect. If anything is off, I dont sleep well and then I dont feel well during the daytime no matter how many Zolofts I take that day.
That is Gospel truth! SuddenlyWornOut, I absolutely love your brute honesty. You completely nailed the situation for me also.

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

Post by SuddenlyWornOut45 » Tue Dec 10, 2013 10:11 am

I gotta tell you. Ive seen a lot of psychiatrists in my life, since my late twenties. The first six or seven years I used to jump around a lot from psychiatrist to psychiatrist, used to enroll in clinical trials for refractory depression. Then I got tired of it all and just started going to one psychiatrist and basically just use this one dude. Frankly I got tired of it all.

I found psychiatrists are basically all the same in their basic approach. I never once found one who had anything truly different. The only difference between them is their temperament, there are some who like to hospitalize their patients at the drop of a hat because they are very afraid of liability (being sued) if a patient commits suicide or even attempts suicide.

Another difference between some psychiatrists is some of them are paranoid about prescribing any controlled substance. Such as benzos such as klonopin or insomnia drugs like ambien. There are some psychiatrists who dont like prescribing controlled stuff at all or keep it very minimalist and short term. And then there are many other psychiatrists who absolutely do not care and they have no qualms about prescribing you a ton of benzos or ambien, dont act afraid to do so or even act like they are doing you a favor for prescribing you longterm benzos.

Ive seen it all from an intensive outpatient psychopharmacology perspective. And I can tell you,there really is not much difference OVERALL between psychiatrists. The main thing about them is they do not want to be caught responsible for YOUR potential suicide or attempted suicide. Thats about it. Its mainly "keep that money coming in or your outta here" and "as long as you dont attempt suicide and take your basic medication, I dont really care what you do." Thats been my personal experience.

The science and technology of psychiatry is very primitive, very backward and very subjective. And thats one of the reasons psychiatrists are the way they are. I used to pay attention to psychiatry research studies. I dont anymore. The only one I pay attention to is that STAR*D clinical trial the NIMH ran years ago. It came to the conclusion that the majority of people prescribed an anti-depressant, even at high doses, DO NOT get a full remission (full recovery) from that anti-depressant. Duh, I already knew that and could have told NIMH that and they could have saved the research money. LOL

I look down on psychiatry. I need their drugs, but I dont see their drugs as a panacea or the true miracle drugs they hype them as. I privately think psychiatry is a big joke, there are some good things about it but a lot of lies and bs about it, a lot of hyping the drugs that they are better than they really are. That being said the drugs do help somewhat, they just dont work as well as psychiatry claims.

I also do not think psychiatry will survive as a branch of medicine another one hundred years. Maybe not even another fifty years. Its just too primitive technologically. Someday, science researchers will really figure out brain science and when that happens someday in the future, psychiatry will be looked at by the masses and by others in medicine as the impotent branch of medicine it really is.

The talk therapists though, they will always be around. There are too many "worried well" females around that just like to go to a therapist, pay money to them and talk and talk and talk about their lives. That group does not want drugs much, they just want the talk psychotherapy and the codependence that develops between therapist and client. Lots of sordid sexual relationships have occurred between many, many female clients and male talk psychotherapists. And many women love it, even though they wont admit it publicly.

Eric

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

Post by jnk » Tue Dec 10, 2013 10:25 am

SuddenlyWornOut45 wrote: . . . I need their drugs . . . there are some good things about it . . . the drugs do help somewhat . . . too primitive technologically. . . .
In my opinion, that's about all that any of us can say about any branch of medicine.
Last edited by jnk on Tue Dec 10, 2013 12:09 pm, edited 1 time in total.

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

Post by ems » Tue Dec 10, 2013 11:31 am

SuddenlyWornOut45 wrote:The talk therapists though, they will always be around. There are too many "worried well" females around that just like to go to a therapist, pay money to them and talk and talk and talk about their lives. That group does not want drugs much, they just want the talk psychotherapy and the codependence that develops between therapist and client. Lots of sordid sexual relationships have occurred between many, many female clients and male talk psychotherapists. And many women love it, even though they wont admit it publicly. Eric


What the hell does this have to do with the price of beans... or anything else for that matter?? And if a woman goes to a talk therapist you consider this a terrible thing? And you are certain lots of sordid sexual relationships have occurred between female clients and male therapists?? How about male clients and male therapists? Or woman/woman?

And, if you "look down on psychiatry", why do you take the drugs they prescribe and you admit you need?? Hypocritical don't you think? You seem to think you know so much... you don't!

Sheesh right back at ya.
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Re: OT? NYT: Sleep therapy seen as aid for treating depression

Post by 49er » Tue Dec 10, 2013 11:33 am

ems wrote:
SuddenlyWornOut45 wrote:The talk therapists though, they will always be around. There are too many "worried well" females around that just like to go to a therapist, pay money to them and talk and talk and talk about their lives. That group does not want drugs much, they just want the talk psychotherapy and the codependence that develops between therapist and client. Lots of sordid sexual relationships have occurred between many, many female clients and male talk psychotherapists. And many women love it, even though they wont admit it publicly. Eric


What the hell does this have to do with the price of beans... or anything else for that matter?? And if a woman goes to a talk therapist you consider this a terrible thing? And you are certain lots of sordid sexual relationships have occurred between female clients and male therapists?? How about male clients and male therapists? Or woman/woman?

And, if you "look down on psychiatry", why do you take the drugs they prescribe and you admit you need?? Hypocritical don't you think? You seem to think you know so much... you don't!

Sheesh right back at ya.
I was going to say something in response but I just couldn't think of the right words. You did it beautifully.

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

Post by SuddenlyWornOut45 » Tue Dec 10, 2013 11:43 am

I go to a psychiatrist because Im a practical kind of guy. I realize I need some of their drugz on a regular basis. So I go to one. But my experiences have been that their drugs work somewhat, they do not make me remit from major depression under normal circumstances. The only one that came reasonable close to that was an MAOI called Parnate, which is very tricky to take and has a ton of very dangerous side effects. I screwed up my blood pressure taking MAOIs.

the comment about females and talk therapists comes from my own longterm observations, going to psychiatrist's and psychologist's offices over the years, observation. Talking to people. Females like the talk therapy thing...a lot. A whole lot. Codependence oftentimes develops out of longterm psychotherapy and if the client is physically attractive, oftentimes it becomes a sexual psychotherapy relationship. Many licensed psychologists have lost their license to practice psychology or social work because of this codependence/sordid sexual encounter issue.

Some females begin to see their therapist as a surrogate boyfriend or husband over time. Some develop crushes on their therapist over time. Weird stuff happens. Trust me.

Eric
ems wrote:
SuddenlyWornOut45 wrote:
What the hell does this have to do with the price of beans... or anything else for that matter?? And if a woman goes to a talk therapist you consider this a terrible thing? And you are certain lots of sordid sexual relationships have occurred between female clients and male therapists?? How about male clients and male therapists? Or woman/woman?

And, if you "look down on psychiatry", why do you take the drugs they prescribe and you admit you need?? Hypocritical don't you think? You seem to think you know so much... you don't!

Sheesh right back at ya.

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

Post by ems » Tue Dec 10, 2013 11:52 am

SuddenlyWornOut45 wrote:I go to a psychiatrist because Im a practical kind of guy. I realize I need some of their drugz on a regular basis. So I go to one. But my experiences have been that their drugs work somewhat, they do not make me remit from major depression under normal circumstances. The only one that came reasonable close to that was an MAOI called Parnate, which is very tricky to take and has a ton of very dangerous side effects. I screwed up my blood pressure taking MAOIs.

the comment about females and talk therapists comes from my own longterm observations, going to psychiatrist's and psychologist's offices over the years, observation. Talking to people. Females like the talk therapy thing...a lot. A whole lot. Codependence oftentimes develops out of longterm psychotherapy and if the client is physically attractive, oftentimes it becomes a sexual psychotherapy relationship. Many licensed psychologists have lost their license to practice psychology or social work because of this codependence/sordid sexual encounter issue.

Some females begin to see their therapist as a surrogate boyfriend or husband over time. Some develop crushes on their therapist over time. Weird stuff happens. Trust me.

Eric
ems wrote:
SuddenlyWornOut45 wrote:
What the hell does this have to do with the price of beans... or anything else for that matter?? And if a woman goes to a talk therapist you consider this a terrible thing? And you are certain lots of sordid sexual relationships have occurred between female clients and male therapists?? How about male clients and male therapists? Or woman/woman?

And, if you "look down on psychiatry", why do you take the drugs they prescribe and you admit you need?? Hypocritical don't you think? You seem to think you know so much... you don't!

Sheesh right back at ya.

Eric, you need to call your psychiatrist... you need more meds than you are already taking!
If only the folks with sawdust for brains were as sweet and obliging and innocent as The Scarecrow! ~a friend~

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

Post by jnk » Tue Dec 10, 2013 12:13 pm

ems wrote: . . . need more meds than you are already taking!
I knew a guy back in my school days who had that exact philosophy.

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

Post by Jim-Bob » Thu Dec 12, 2013 12:36 am

SuddenlyWornOut45 wrote:As someone who was formally diagnosed with severe depression long before I was ever put on CPAP, what you are claiming is bs. I never felt better, in anyway shape or form when my sleep quality deteriorated. In fact, deterioration of sleep quality, insomnia and such is one of the main things psychiatrists and psychologists look for when evaluating someone for depression and also for severity of depression.

Sleep restriction or "sleep deprivation" is also well documented for causing psychosis. Stay awake long enough no matter who you are (mentally ill or not mentally ill) and you WILL hallucinate!!

Eric
Jim-Bob wrote:
jnk wrote:
But making sleep worse can make some brain problems better. At any rate, sleep restriction can be a therapeutic treatment for depression.
http://www.ncbi.nlm.nih.gov/pubmed/2058 ... olding=npg


http://www.nature.com/tp/journal/v3/n1/ ... 2136a.html