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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by LostBoyinNCBecksDark on October 23, 2007, at 19:01:42
"In fact, psychologist Matthew Walker of the University of California, Berkeley, says that "almost all psychiatric disorders show some problems with sleep.'' But, he says that scientists previously believed the psychiatric problems triggered the sleep issues. New research from his lab, however, suggests the reverse is the case; that is, a lack of shut-eye is causing some psychological disturbances."
Duh...
Better get a sleep study done if you haven't had one already.
http://www.sciam.com/article.cfm?articleid=CDEFA259-E7F2-99DF-311007C6099FD8A2&chanId=sa017
Eric
Posted by LostBoyinNCBecksDark on October 23, 2007, at 19:11:52
In reply to Study claims sleep deprivation causes psych probs, posted by LostBoyinNCBecksDark on October 23, 2007, at 19:01:42
"The emotional centers of the brain were over 60 percent more reactive under conditions of sleep deprivation than in subjects who had obtained a normal night of sleep," Walker said."
http://www.sciencedaily.com/releases/2007/10/071022124729.htmhttp://www.usatoday.com/tech/science/discoveries/2007-10-22-sleep-deprivation-brain_N.htm
"The study also suggests that lack of sleep elevates activity in the emotional centers of the brain most closely associated with psychiatric disorders such as depression."
Save your brain...get good quality sleep.
Eric
Posted by d0pamine on October 23, 2007, at 19:22:52
In reply to Re: Drugs wont help much if sleep is messed up bad, posted by LostBoyinNCBecksDark on October 23, 2007, at 19:11:52
I simply can't accept that I'm supposed to sleep like this...
http://www.karmatruck.com/TonyCPAP2001A.jpg
Hooking my face up to a backward vacuum cleaner every night sound like every bit as much of a bandaid as anything else. Besides without meds one of my problems is that I can lay down and go to sleep and stay that way for days.
Posted by Sigismund on October 23, 2007, at 19:34:17
In reply to Study claims sleep deprivation causes psych probs, posted by LostBoyinNCBecksDark on October 23, 2007, at 19:01:42
Hey Eric
I don't have sleep apnea, but I don't get sufficient slow wave sleep, and I take around 10mg/d Valium that I probably will never be able to give up, certainly not while my sleep is like it is.
Any suggestions?
Posted by Maxime on October 23, 2007, at 19:34:28
In reply to Study claims sleep deprivation causes psych probs, posted by LostBoyinNCBecksDark on October 23, 2007, at 19:01:42
I can't believe they got funding for that study. Of course lack of sleep causes psych problems!
Maxime
Posted by LostBoyinNCBecksDark on October 23, 2007, at 19:43:14
In reply to Re: Study claims sleep deprivation causes psych pr » LostBoyinNCBecksDark, posted by Sigismund on October 23, 2007, at 19:34:17
> Hey Eric
>
> I don't have sleep apnea, but I don't get sufficient slow wave sleep, and I take around 10mg/d Valium that I probably will never be able to give up, certainly not while my sleep is like it is.
>
> Any suggestions?No, not really. I try to not play Internet doctor anymore, I try not to make specific suggestions to people on the net for several reasons. Only thing I can suggest is to ask your doctor(s) and if your doctor(s) dont give you a satisfactory answer, find one whose specialty is sleep medicine and not psychiatry.
There are some psychiatrists who are also trained as sleep docs. I dont know how good they'd be, psychiatry being the way it is and all. I prefer my sleep doc to be either a pulmonary doctor or a Neurologist. I never went to a shrink that ever impressed me technically or medically. And Ive been to a bunch of them.
Just FYI, after I started CPAP, my blood pressure dropped a good amount along with a dramatic drop in anxiety, irritability and agitation. I was able to get off of the benzo klonopin as a direct result of CPAP and I dont miss the stuff.
Eric
Posted by LostBoyinNCBecksDark on October 23, 2007, at 19:49:58
In reply to Re: Study claims sleep deprivation causes psych probs, posted by Maxime on October 23, 2007, at 19:34:28
> I can't believe they got funding for that study. Of course lack of sleep causes psych problems!
>
> Maxime
Yeah, but think of it this way. Most people think of depressed people as being these super tired, sad, irritable people who sleep all the time. Most people take sleep for granted, including most doctors and scientists. Depressed people might sleep a lot, but WHAT KIND OF SLEEP...or what quality of sleep are they getting? If you sleep ten or more hours a day but its cruddy, shallow, nonrestorative sleep that never or rarely gets you down into good, deep restorative sleep (slow wave sleep), that ten or more hours of sleep is not worth much.Factor in most psych meds suppress deep stage sleep and it makes sense that a lot of depressed people claim they never make much improvement.
We need more studies like this, along with a lot studies in psychiatric genetics studies. If mental health people could ever get away from this idea that its mostly your environment (bad parenting, rough childhood) and move into the 21st century along with the rest of the medical world, the mentally ill might not have to suffer as much.
Eric
Posted by Netch on October 23, 2007, at 20:10:49
In reply to Study claims sleep deprivation causes psych probs, posted by LostBoyinNCBecksDark on October 23, 2007, at 19:01:42
> "In fact, psychologist Matthew Walker of the University of California, Berkeley, says that "almost all psychiatric disorders show some problems with sleep.'' But, he says that scientists previously believed the psychiatric problems triggered the sleep issues. New research from his lab, however, suggests the reverse is the case; that is, a lack of shut-eye is causing some psychological disturbances."
>
> Duh...
>
> Better get a sleep study done if you haven't had one already.
>
> http://www.sciam.com/article.cfm?articleid=CDEFA259-E7F2-99DF-311007C6099FD8A2&chanId=sa017
>
>
> EricI agree... many mental disorders will improve if
sleep quality improves.
But a sleep study would only confirm what I already know./Netch
Posted by Sigismund on October 23, 2007, at 20:56:49
In reply to Re: Study claims sleep deprivation causes psych probs » LostBoyinNCBecksDark, posted by Netch on October 23, 2007, at 20:10:49
>I agree... many mental disorders will improve if
sleep quality improves.Am I right in thinking that there is currently no way of improving sleep quality (if you do not have sleep apnea), apart from Remeron (which is too awful for me).
Posted by LostBoyinNCBecksDark on October 23, 2007, at 21:37:52
In reply to Re: Study claims sleep deprivation causes psych pr » Netch, posted by Sigismund on October 23, 2007, at 20:56:49
> >I agree... many mental disorders will improve if
> sleep quality improves.
>
> Am I right in thinking that there is currently no way of improving sleep quality (if you do not have sleep apnea), apart from Remeron (which is too awful for me).The newer, FDA approved insomnia meds like Ambien, Sonata, Lunesta are claimed not to suppress slow wave and REM sleep like traditional benzos. I dont know how much of that is really true and how much of it is drug company marketing though. I must assume it is basically true though, as the FDA approved these meds on the idea that they are effective for insomnia without disturbing sleep architecture much.
The thing is, these anti-insomnia hypnotic drugs are not effective for anxiety like the traditional benzos are. If you take traditional benzos mainly for sleep and insomnia, you might could switch to a newer FDA approved sleep med. But if you have both insomnia AND daytime anxiety, I dont know what youd do.
The atypical anti-psychotics are supposed to increase slow wave sleep, but taking them for depression and anxiety is stretching things a bit. Many psychiatrists have cut back on prescribing atypicals people who are not psychotic or manic, but "just" clinically depressed and/or having bad anxiety. This is due to the black box blood sugar/diabetes warnings that goes with all atypical anti-psychotics.
Take a drug to treat one thing and end up with an entirely new illness! Diabetes. Pretty smart, huh? <eye roll>
I know Pdocs used to rx low dose Seroquel (25-50 mg) a lot for insomnia and that is an atypical AP. But I dont know how much that goes on anymore. I know my shrink is real tight with neuroleptics and doesnt want me on any atypical AP.
I guess you could say there is a big gap there for anxiety meds, from the standpoint of does it screw your sleep architecture up? Or does it improve your sleep architecture? All traditional benzos suppress slow wave sleep, as do all SSRI antidepressants.
I guess the drug companies need to get back in the labs.
Eric
Posted by Phillipa on October 23, 2007, at 22:08:55
In reply to Re: Study claims sleep deprivation causes psych pr » Netch, posted by Sigismund on October 23, 2007, at 20:56:49
I do know of one med lunesta improves sleep architecture and the stages of sleep. Phillipa
Posted by Phillipa on October 23, 2007, at 22:12:25
In reply to Re: Study claims sleep deprivation causes psych pr, posted by LostBoyinNCBecksDark on October 23, 2007, at 21:37:52
Eric you are so right I have a source who has filled me on on these meds. Correspond with him now. I would use the lunesta instead of valium if I had the $85 a month as medicaire will not cover it. I had a couple coupons in the beginning it helped. Phillipa
Posted by yxibow on October 28, 2007, at 23:36:16
In reply to Re: Study claims sleep deprivation causes psych pr » LostBoyinNCBecksDark, posted by Phillipa on October 23, 2007, at 22:12:25
> Eric you are so right I have a source who has filled me on on these meds. Correspond with him now. I would use the lunesta instead of valium if I had the $85 a month as medicaire will not cover it. I had a couple coupons in the beginning it helped. Phillipa
If you're used to benzodiazepines, pseudobenzodiazepine agents like Lunesta, Ambien, Sonata, etc probably aren't as effective. But then again, everyone is different.
Generally Ambien -> Lunesta -> Sonata in decreasing order of potency, unless you are rx'd Ambien at 20mg or Lunesta at 4mg, e.g.
If you've never taken Seroquel, Seroquel at even 12.5mg would probably induce sleep and the D2 binding would be nearly insignificant. Still one can understand hesitation, I know. No single agent is completely benign.
Posted by alan2102 on October 29, 2007, at 21:36:01
In reply to Re: Study claims sleep deprivation causes psych pr » Netch, posted by Sigismund on October 23, 2007, at 20:56:49
> >I agree... many mental disorders will improve if
> sleep quality improves.
>
> Am I right in thinking that there is currently
> no way of improving sleep qualityClinical perspectives for the use of melatonin as a chronobiotic and cytoprotective agent.
The circadian time system involves periodic gene expression at the cellular level, synchronized by a hierarchically superior structure located in the hypothalamic suprachiasmatic nuclei. Treatment of circadian rhythm disorders has led to the development of a new type of agent called “chronobiotics,” among which melatonin is the prototype. In elderly insomniacs, melatonin treatment decreased sleep latency and increased sleep efficiency, particularly slow-wave sleep. The effect of melatonin on sleep is the consequence of increasing sleep propensity (by augmenting the amplitude of circadian clock oscillation via MT1 receptors) and of synchronizing the circadian clock via MT2 receptors. Daily melatonin production decreases with age and in several pathologies, attaining its lowest values in Alzheimer’s disease (AD) patients. About 45% of AD patients have disruptions in their sleep and “sundowning” agitation. Generally, melatonin treatment decreases sundowning in AD patients and reduced variability of sleep onset time. Both open and controlled studies have indicated a significant decrease of cognitive deterioration in AD patients treated with melatonin. The mechanisms accounting for the possible therapeutic effect of melatonin in AD patients may be manifold. On one hand, melatonin treatment promotes slow-wave sleep in the elderly and could be beneficial by augmenting the restorative phases of sleep. On the other hand, melatonin protects neurons against beta-amyloid toxicity. By its combined chronobiotic and cytoprotective properties melatonin provides an innovative neuroprotective strategy to reduce the cost of lifetime treatment of some neuropsychiatric disorders.
Ann N Y Acad Sci. 2005 Dec;1057:327-36.
Posted by Astounder on October 31, 2007, at 11:15:01
In reply to Re: Study claims sleep deprivation causes psych pr, posted by LostBoyinNCBecksDark on October 23, 2007, at 21:37:52
> > >I agree... many mental disorders will improve if
> > sleep quality improves.
> >
> > Am I right in thinking that there is currently no way of improving sleep quality (if you do not have sleep apnea), apart from Remeron (which is too awful for me).
>
> The newer, FDA approved insomnia meds like Ambien, Sonata, Lunesta are claimed not to suppress slow wave and REM sleep like traditional benzos. I dont know how much of that is really true and how much of it is drug company marketing though. I must assume it is basically true though, as the FDA approved these meds on the idea that they are effective for insomnia without disturbing sleep architecture much.
>
> The thing is, these anti-insomnia hypnotic drugs are not effective for anxiety like the traditional benzos are. If you take traditional benzos mainly for sleep and insomnia, you might could switch to a newer FDA approved sleep med. But if you have both insomnia AND daytime anxiety, I dont know what youd do.
>
> The atypical anti-psychotics are supposed to increase slow wave sleep, but taking them for depression and anxiety is stretching things a bit. Many psychiatrists have cut back on prescribing atypicals people who are not psychotic or manic, but "just" clinically depressed and/or having bad anxiety. This is due to the black box blood sugar/diabetes warnings that goes with all atypical anti-psychotics.
>
> Take a drug to treat one thing and end up with an entirely new illness! Diabetes. Pretty smart, huh? <eye roll>
>
> I know Pdocs used to rx low dose Seroquel (25-50 mg) a lot for insomnia and that is an atypical AP. But I dont know how much that goes on anymore. I know my shrink is real tight with neuroleptics and doesnt want me on any atypical AP.
>
> I guess you could say there is a big gap there for anxiety meds, from the standpoint of does it screw your sleep architecture up? Or does it improve your sleep architecture? All traditional benzos suppress slow wave sleep, as do all SSRI antidepressants.
>
> I guess the drug companies need to get back in the labs.
>
> EricAnxiolytic that improves sleep quality? Here's a study that shows gabapentin improves sleep in the presence of alcohol: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17566190&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
I've tried it and it works pretty well. Reduces REM and stage 1, while increasing slow-wave, reduces awakenings, and doesn't cause oversleeping. Normally alcohol increases stage 1 and decreases both slow-wave & REM, and causes fragmentation/awakenings. Shame I hate the taste of alcohol.You could also try combining kava (mood elevating & anxiolytic) with benadryl or doxylamine (antihistamines increase slow-wave sleep & suppress REM), which worked pretty well until I developed tolerance to the antihistamines.
Trazodone and Seroquel cause sedation mostly through alpha-blocking, and both robustly increase slow-wave with little evidence of tolerance or REM suppression. Trazodone also reverses the insomnia from SSRIs via 5HT2a blockade, while Seroquel can reverse the insomnia from psychostimulants via D2 blockade. Neither of them make you feel very good. Seroquel is the best of the atypicals for this because of its low neuroleptic potency, its short 6 hr half-life, and low likelyhood of causing insulin tolerance.
Among benzos I developed immediate tolerance to the sedative effects of Ativan and Klonopin. Ambien makes me trip balls, and when I switched rapidly from high-dose Remeron (the sedative effects I had become completely tolerant to) to Lunesta, the REM rebound was so profound I became delirious and had to be hospitalized.
For true anxiolysis & mood elevation while improving your sleep architecture and decreasing daytime sleepiness, there's the holy grail of hypnotics, Xyrem. Good luck getting a prescription.
For a while I've been taking 25 mg Seroquel, 50 mg Benadryl, and 3 mg melatonin, but often don't end up taking them. I'm going to try the opposite approach from using sedatives to sleep from now on: Wake myself up with stimulants & bright light therapy in morning and wait for the inevitable crash that forces me to go to sleep at night.
Posted by Phillipa on October 31, 2007, at 20:09:54
In reply to Re: Study claims sleep deprivation causes psych pr, posted by Astounder on October 31, 2007, at 11:15:01
So are you saying that alchohol increases good sleep as when I drank 4-6 beers a night I felt wonderful the next day no hangover,lots of energy, no depression, and most importantly very happy and fulfilled. Phillipa
Posted by yxibow on October 31, 2007, at 23:34:29
In reply to Re: Study claims sleep deprivation causes psych pr » Astounder, posted by Phillipa on October 31, 2007, at 20:09:54
> So are you saying that alchohol increases good sleep as when I drank 4-6 beers a night I felt wonderful the next day no hangover,lots of energy, no depression, and most importantly very happy and fulfilled. Phillipa
Alcohol may produce sleep for someone once but the chance of hangovers and other nasty things are quite likely. Its not really a good choice. I'm sure you're among the exceptions but it really doesn't give a "good nights sleep".
Combined with sleep agents it potentiates the CNS depressant effect and can cause respiratory depression, not a good thing.
Posted by Astounder on November 1, 2007, at 10:06:57
In reply to Re: Study claims sleep deprivation causes psych pr » Phillipa, posted by yxibow on October 31, 2007, at 23:34:29
> > So are you saying that alchohol increases good sleep as when I drank 4-6 beers a night I felt wonderful the next day no hangover,lots of energy, no depression, and most importantly very happy and fulfilled. Phillipa
>
> Alcohol may produce sleep for someone once but the chance of hangovers and other nasty things are quite likely. Its not really a good choice. I'm sure you're among the exceptions but it really doesn't give a "good nights sleep".
>
> Combined with sleep agents it potentiates the CNS depressant effect and can cause respiratory depression, not a good thing.Yeah, you develop tolerance to alcohol's sedative effects rapidly, and it starts to fragment sleep after as little as one day of use (similar to chloral or midazolam). Only with gabapentin--and by extension, pregabalin--does it seem that it doesn't hurt architecture, but rather improves it.
Posted by FredPotter on November 1, 2007, at 14:43:03
In reply to Re: Drugs wont help much if sleep is messed up bad, posted by d0pamine on October 23, 2007, at 19:22:52
I find excessive sleep is full of dreams and probably counter-productive. I seem to do best on 7 hours of quality sleep rather than on 16 hours of tormented REM
Posted by d0pamine on November 1, 2007, at 15:58:43
In reply to Re: Drugs wont help much if sleep is messed up bad » d0pamine, posted by FredPotter on November 1, 2007, at 14:43:03
Tormented REM doesn't sound very productive sure enough.
Posted by Phillipa on November 1, 2007, at 20:11:25
In reply to Re: Study claims sleep deprivation causes psych pr » yxibow, posted by Astounder on November 1, 2007, at 10:06:57
Didn't happen to me for many years my only sleep med was the beer and always worked. I was put on chloral hydrate when high doses of benzos were added to take the place of the beer. Took that without any alchohol and no stopping wasn't a problem. Just haven't had a drink in ll years. The chloral hydrate took for about five years and weaned off it now just the valium. Yes aware that chloral hydrate and alchohol are a Mickey Finn. Phillipa
Posted by LostBoyinNCBecksDark on November 8, 2007, at 22:49:00
In reply to Re: Study claims sleep deprivation causes psych pr » Astounder, posted by Phillipa on October 31, 2007, at 20:09:54
> So are you saying that alchohol increases good sleep as when I drank 4-6 beers a night I felt wonderful the next day no hangover,lots of energy, no depression, and most importantly very happy and fulfilled. Phillipa
Alcohol causes sleep fragmentation. It is a poor insomnia medication.
Eric
This is the end of the thread.
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