Sleep medicine

Insomnia Cure Boosts Success of Depression Treatment.

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reating persistent insomnia at the same time as depression could double the chances that the mood disorder will disappear, a new study shows.

Doctors have long reported a link between insomnia — the inability to sleep — and depression, but many thought that depression led to insomnia. Now, experts suspect sleep problems can sometimes precede depression.

If other ongoing studies confirm these results, it might lead to major changes in depression treatment, experts added. Such changes would represent the biggest advance in depression treatment since the antidepressant Prozac was introduced in 1987, The New York Times reported.

“The way this story is unfolding, I think we need to start augmenting standard depression treatment with therapy focused on insomnia,” Colleen Carney, lead author of the small study, told the Times.

The study was funded by the U.S. National Institute of Mental Health.

The insomnia treatment relied on talk therapy, rather than sleep medication, for 66 patients.

Insomnia and depression are both common problems, and often interact, explained Dr. Steven Feinsilver, director of the Center for Sleep Medicine at Mount Sinai School of Medicine in New York City. He was not involved in the study.

“Clearly, poor sleep can cause depression and depression can cause poor sleep,” he said.

Evidence does exist that for many people, symptoms of insomnia precede symptoms of depression by a few years, Feinsilver noted. “This could be taken to mean either that insomnia causes depression or that insomnia is the earliest symptom of depression,” he said.

This study may help untangle that relationship. It “suggests that specifically treating the insomnia with behavioral techniques can substantially improve the outcome of patients with depression,” Feinsilver added.

For the millions of people with depression, the findings offer a ray of hope.

“This relatively simple technique for treating insomnia could be tremendously helpful for those with this common psychiatric illness,” Feinsilver said.

More than 20 million Americans suffer from depression — disabling feelings of sadness and despair that don’t go away, according to the U.S. National Library of Medicine. More than half of those with depression also suffer from insomnia.

The research team, from Ryerson University in Toronto, found depression lifted significantly among patients whose insomnia was cured. The insomnia treatment consisted of four talk therapy sessions over eight weeks, according to the Times.

During the sessions, patients were given certain instructions: set a specific wake-up time and don’t veer from it; get out of bed when awake but don’t eat, read or watch TV; and refrain from taking any daytime naps.

Almost 90 percent of patients who responded to the insomnia therapy also saw their depression lift after taking an antidepressant pill or an inactive placebo for two months. That was about double the rate of those who could not shake their sleeplessness, the news report said.

Study participants had to have had a month of sleep loss that had an effect on their jobs, family life or other relationships.

A smaller pilot study conducted at Stanford University produced similar findings, the Times reported.

Carney was to present the latest research Saturday at a conference of the Association for Behavioral & Cognitive Therapies, in Nashville, Tenn., the newspaper reported.

Research presented at meetings should be viewed as preliminary until published in a peer-reviewed medical journal.

Late afternoon and early evening caffeine can disrupt sleep at night.

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A new study shows that caffeine consumption even six hours before bedtime can have significant, disruptive effects on sleep.

“Sleep specialists have always suspected that caffeine can disrupt sleep long after it is consumed,” said American Academy of Sleep Medicine President M. Safwan Badr, MD.  “This study provides objective evidence supporting the general recommendation that avoiding caffeine in the late afternoon and at night is beneficial for sleep.”

Results show that 400 mg of caffeine (about 2-3 cups of coffee) taken at bedtime, three and even six hours prior to bedtime significantly disrupts sleep. Even when caffeine was consumed six hours before going to bed, objectively measured total sleep time was dramatically reduced (more than one hour).  However, subjective reports suggest that participants were unaware of this sleep disturbance.

The study is in the Nov. 15 issue of the Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine.

“Drinking a big cup of coffee on the way home from work can lead to negative effects on sleep just as if someone were to consume caffeine closer to bedtime,” said lead author Christopher Drake, PhD, investigator at the Henry Ford Sleep Disorders and Research Center and associate professor of psychiatry and behavioral neurosciences at Wayne State University in Detroit, Mich. “People tend to be less likely to detect the disruptive effects of caffeine on sleep when taken in the afternoon,” noted Drake, who also is on the board of directors of the Sleep Research Society.

Drake and his research team studied 12 healthy normal sleepers, as determined by a physical examination and clinical interview. Participants were instructed to maintain their normal sleep schedules.  They were given three pills a day for four days, taking one pill at six, three and zero hours prior to scheduled bedtime.  One of the pills contained 400 mg of caffeine, and the other two were a placebo.  On one of the four days, all three pills were a placebo.  Sleep disturbance was measured subjectively with a standard sleep diary and objectively using an in-home sleep monitor.

According to the authors, this is the first study to investigate the effects of a given dose of caffeine taken at different times before sleep.  The results suggest that caffeine generally should be avoided after 5 p.m. in order to allow healthy sleep.

Could Oral FacialTherapy Be the Answer for Sleep Apnea?

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Not sleeping well? You’re not alone… A recently published study1 from Sweden highlights just how common more severe sleep problems, like sleep apnea, might be. Apnea is a Greek word that means “breathe.” Sleep apnea is the inability to breathe properly, or the limitation of breath or breathing, during sleep.

The study, which included 400 women ranging in age between 20-70, found that hmycoalf of them had mild to severe sleep apnea. Among women with hypertension or who were obese, the numbers were even higher – 80 to 84 percent of them had sleep apnea. This is significant, as sleep apnea is tied to higher risks of stroke, silent brain infarction2, heart attack, and early death.

As reported by Reuters:3

“Each apnea event was defined by at a least a 10-second pause in breathing accompanied by a drop in blood oxygen levels. Women who had an average of five or more of these events during each hour of sleep were considered to have sleep apnea.

The study, which was funded by the Swedish Heart Lung Foundation, found that apnea became more common in the older age groups. Among women aged 20-44, one quarter had sleep apnea, compared to 56 percent of women aged 45-54 and 75 percent of women aged 55-70.

…Severe sleep apnea, which involves more than 30 breathing disruptions per hour, was far less common. Just 4.6 percent of women 45-54 and 14 percent of women 55-70 had severe cases. Among women of all ages with hypertension, 14 percent had severe sleep apnea, and among women who were obese, 19 percent had severe apnea.”

What is Sleep Apnea?

There are three general types of sleep apnea described in the medical literature:

  • Central apnea, which typically relates to your diaphragm and chest wall and an inability to properly pull air in
  • Obstructive apnea, which relates to an obstruction of your airway that begins in your nose and ends in your lungs
  • Mixed apnea is a combination of both

Obstructive sleep apnea consists of the frequent collapse of the airway during sleep, making it difficult for victims to breathe for periods lasting as long as 10 seconds. Those with a severe form of the disorder have at least 30 disruptions per hour. Not only do these breathing disruptions interfere with sleep, leaving you unusually tired the next day, it also reduces the amount of oxygen in your blood, which can impair the function of internal organs and/or exacerbate other health conditions you may have.

Signs and Symptoms of Sleep Apnea

Your body is constantly working to keep you alive – it’s in constant CPR mode, if you will. So at night, your body is constantly shifting and compensating to keep you breathing. One sign that you’re having trouble breathing is when your body compensates with increased forward head posture when sleeping. The worse your apnea gets, the more pronounced this forward posture becomes, because pulling your head forward helps compensate for the lack of room behind the back of your tongue.

Another common compensation that can indicate sleep apnea is frequent tossing and turning at night. This is because when you’re laying on your back, gravity will pull your jaw and tongue backward, further into your throat, which can obstruct breathing. Hence, tossing and turning may be your body’s way of keeping you breathing.

Snoring is another indication that you may have sleep apnea.

A simple test you can perform to check whether or not you’re breathing properly is to stand with your back against a wall, with your heels, buttocks, shoulder blades and head touching the wall. Say “Hello,” swallow, and then breathe. If you can speak, swallow, and breathe easily and comfortably in this position, then your mouth and throat are clear. If you cannot perform those three functions, your breathing is probably obstructed, which may be exacerbated when lying down to sleep.

Of course you could also have a professional evaluation in a sleep laboratory for a more comprehensive diagnosis. One useful new inexpensive tool for under $100 is the Zeo, which is available on Amazon. It is essentially a sleep lab that you can perform every night. It will not only tell you how long you are sleeping but when you wake up, how long you are up for, the length and times of your REM, light, and deep sleep. It then provides you with a summary sleep score that can tell you how well you slept during the night. You can then use this information to help fine tune your sleep program and monitor the effectiveness of any intervention.

You Don’t have to Be Obese to Suffer from Sleep Apnea

Years ago, sleep apnea was thought to be primarily associated with morbid obesity, which clearly can be a significant contributing factor. However, many patients diagnosed with sleep apnea today do not have a weight problem. So what’s really causing your sleep apnea?

The primary issue appears to be related to the shape and size of your mouth, and the positioning of your tongue.

The conventional treatment for sleep apnea is a machine called CPAP, which is an acronym for “continuous positive airway pressure.” The machine creates a forceful pressure that mechanically opens up your airway. But that does not address the cause of the problem, although it may provide some symptom relief.

According to Dr. Arthur Strauss, a dental physician and a diplomat of the American Board of Dental Sleep Medicine, our mouths have progressively gotten smaller through the generations due to lack of breastfeeding and poor nutrition. Breastfeeding actually helps expand the size of your child’s palate and helps move the jaw further forward – two factors that help prevent sleep apnea by creating more room for breathing. Diet is also important. Dr. Weston Price‘s pioneering work showed how diet can affect your entire mouth, not just your teeth.

If your sleep apnea is related to your tongue or jaw position, specialty trained dentists can design a custom oral appliance to address the issue. These include mandibular repositioning devices, designed to shift your jaw forward, while others help hold your tongue forward without moving your jaw. However, sleep apnea relief may also be found in the form of speech therapy treatment…

Oral Myofunctional Therapy Shown Effective for Sleep Apnea

My girlfriend, who is in no way obese, has suffered from obstructive sleep apnea for most of her adult life and it had nearly destroyed her physical health from insomnia. I recently became aware of a form of therapy called oral myofunctional therapy, which appears to have great promise for the treatment of sleep apnea. Essentially, it’s an exercise program for your mouth and tongue.

I had interviewed a dental hygienist, Carol Vander Stoep, and while in our video studio she quickly evaluated me and told me I was “tongue tied” and that it might be affecting my health. I was surprised, so I obtained an evaluation by Joy Moeller, the leading orofacial myologist in the US, and she confirmed it. So I consulted with her and started on some mouth exercises and in less than a week I noticed a remarkable improvement in my time in deep sleep as objectively measured by the Zeo. The program takes about one year to change the muscles and increase the size of the oral cavity to decrease obstructive sleep apnea, but I actually may have been suffering from this my whole life and never knew it. I will certainly keep you posted of my progress.

Although this therapy is widely known in Brazil, it is relatively unheard of in the US. As Joy explains:4

“Myofunctional therapy, also called orofacial myology, is the neuromuscular re-education or re-patterning of the oral and facial muscles. It might include muscle exercises, which create a normal freeway space dimension. Therapists are trained to eliminate negative oral habits through behavior modification techniques and promote positive growth patterns. We train people to breathe through their noses if their airways are not compromised, and if the oral breathing is an acquired habit; we teach people how to properly position their tongue at rest; we teach how to chew and swallow correctly, and we emphasize the importance of proper head and neck posture patterns.

…Therapy usually starts with establishing nasal airway (after clearance from an ENT and an Allergist) and developing a lip seal. If a patient habitually breathes through his/her mouth, the tongue rests down and the mandible drops down and back. The palate, in turn, might not develop correctly. A good myofunctional therapist will assist the patient to clear his/her nose, use correct abdominal (diaphragmatic) breathing, and then establish habitual nasal breathing.”

According to a 2007 case report published in International Archives of Otorhinolaryngology:5

“Speech therapy treatment could be considered a new therapy for snoring and obstructive sleep apnea patients because of its direct action on oral motility. The myofunctional therapy includes the correct use of the stomatognatic structures and functions by means of functional exercises (respiratory, suction, swallowing and chewing) and muscular exercises with the aim of increasing the tonus and mobility of oral and cervical structures, which can be damaged in apneic patients.”

The paper includes the case histories of two subjects, one male and one female, both of whom experienced “extreme regression of the syndrome.”

Home Testing Technologies

Myofunctional therapy strikes me as an excellent first step if you suspect you might have sleep apnea, before you start sinking money into sleep studies, expensive machines, and/or oral surgery. Furthermore, there are technologies available that can help you determine whether or not you may have a problem that may require seeing a specialist. These home technologies can also be used to evaluate how well an oral appliance is working. For example, you can:

  • Measure your snoring with iPhone apps
  • Record the sounds of you sleeping using Audacity, a free software program available online
  • Measure your blood oxygen levels with an oximeter. Oftentimes, if you have sleep apnea, you’re going to have a drop in blood oxygen. When it drops to a certain level, it indicates you have a problem

To learn more about sleep apnea, check out the American Academy of Dental Sleep Medicine’s website. Dental sleep medicine is an area of medicine that focuses on the management of sleep-related breathing disorders.

Source: Dr. Mercola