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Sleep Problems: More Than a Symptom

“When a new patient comes to the practice, the first fundamental issue we address is quality of sleep,” notes Dr. Mona Gupta, a highly respected Raleigh psychiatrist.

Dr. Gupta

“How are they sleeping? How many hours are they sleeping? Through the night or intermittent? Bothered by bad dreams or nightmares? Do they need and use sleep aids? Do they snore? Do they believe they have a breathing issue during the night?—these are all key questions.

“Quality of sleep is such a crucial issue—its importance can’t be overstated. It affects all parts of our lives. With poor quality of sleep, a patient is likely to become anxious and irritable, and even experience auditory or visual hallucinations. Indeed, the patient experiencing poor quality of sleep can appear to be schizophrenic or even bipolar.”

Sleep and Mental Health

Traditionally, notes Dr. Gupta, “clinicians treating psychiatric patients have regarded sleep disorders as symptoms. But research increasingly suggests that sleep problems not only increase the risk for psychiatric disorders, but directly contribute to their development.

Sleep Apnea:
A First-Hand Experience

“My husband’s experience with obstructive sleep apnea was typical and memorable,” says Dr. Gupta. “It included regular, aggressive snoring and gasping for air, along with sounds of choking and loud snoring, which often drove me out of our bedroom.

“And in typical fashion, he was eventually fitted with a CPAP machine, which made a dramatic difference—with important reser-vations. CPAP stands for Controlled Positive Air Pressure, and the device does a wonderful job in controlling the intake and expir-tion of air in a measured way while sleeping. It continues to be the gold standard for many thousands of people who are dealing with, and living with, serious sleep apnea.

“But CPAP devices tend to be bulky and noisy, and cumbersome when traveling. So, over time, my husband—like many others— stopped using this very useful device, and of course his apnea symptoms returned.

“About the same time, as a dentist, he began taking courses about the creation and use of oral mandibular devices worn while sleeping to offset the symptoms of sleep apnea. He was fitted for his own device, and the blessing is, it worked like a charm. No more CPAP! And no more snoring and gasping for air!

“This little device, which of course travels easily, has made a huge difference in his life, and in mine. In his article in this issue, he shares how his enthusiasm for this outcome has led him to become a national leader in the presentation of information and instruction to hundreds of dentists throughout the country about the dangers of sleep apnea, and the highly effective ways to measure and control the impact of the problem when it exists.

“Now when I work with patients who are screened for sleep apnea, I am so pleased to know there is a reasonable, comfortable alternative they can consider that may have a direct and powerful impact on their feelings of depres-sion and the quality of their relationships—in fact, in all aspects of their health and lives. Sleep apnea, undiagnosed and treated, increases the likelihood of cardio-vascular issues and sexual issues and concentration issues, as well as depression and obesity. This little oral device has had a huge impact on the quality of life of a great many people.”

“Lack of sleep affects us all,” she explains. “It reduces impulse control and impairs cognitive function, and has been associated with an increased risk for suicidal thoughts and attempted suicide. And for those with mental health problems—such as depression or anxiety—the impact of sleep deprivation is amplified.”

For example, she points out, “chronic sleep problems affect 50-80 percent of psychiatric patients, compared with 10-18 percent of the general population. And sleep problems are particularly common in patients suffering from depression, anxiety, bipolar disorder, and ADHD.”

Understanding the Nature of Sleep Problems

“It is generally now accepted,” notes Dr. Gupta, “that quality of sleep is as vital a health indicator as blood pressure, temperature, heart rate, weight, and height—the commonly used measures for diagnosis by virtually all medical providers, including psychiatrists. And, as we assess quality of sleep, we learn a great deal about the client’s overall health. The impact of sleep apnea can be life-threatening and dramatic.”

Dr. Gupta comments that she may be one of the few psychiatrists who lean heavily on sleep studies. “I did my psychiatric residency at Wake Forest University, and the chairman of the department, Dr. Ron Bacall, was sleep-certified. He did research on sleep, and conducted sleep studies—and in one of his studies he diagnosed my husband with sleep apnea, which changed my husband’s life immeasurably for the better. It is a condition that can be the root cause of anxiety, depression, heart problems, and other serious health conditions—all of which can be and often are treated medically without actually getting to the underlying issue: the presence of sleep apnea.”

Restorative Sleep

“If someone comes to me because they are having trouble sleeping,” notes Dr. Gupta, “I don’t simply say ‘Here’s a medication that will help.’ Scientifically, that medicine may be very appropriate for the patient to address a chemical imbalance. But I want to understand the cause of the sleep problem. What is going on in their life? Are they exercising? Are they taking care of themselves in other ways? Are they working too much? Are they balancing all parts of their life? Do they give themselves permission to play?”

In addressing patients’ sleep problems, Dr. Gupta says that she finds herself “very frequently encouraging people to find hobbies to help heal their hurts, beyond what we can offer in medicine and therapy. It’s not an approach I was taught in medical school, but after more than a decade of listening to and working with people who are in pain, and out of balance in some part of their lives, I often find that creative play that people truly love is powerful therapy.”

And, she continues, “professional help is often an important choice. Some of my patients need a sleep study, to get a much better understanding of what is happening in their bodies as they often twist and turn with restless sleep.”