Sleep and Persistent Teen Depression

The following is information from the 2017 31st Annual Meeting of the Associated Sleep Societies

Sleep-disordered breathing (SDB) may play a role in persistent depressive symptoms and poor response to standard pharmacologic treatments in adolescents. Screening adolescents with treatment resistant depression (TRD) for SDB “may be clinically valuable, since SDB is readily treatable.” Said Teena Chase, MD, PHD, Department of Psychiatry, University of Ottawa, Ontario, Canada, during her oral presentation. She also noted diagnosing and treating SDB may improve clinical outcomes early in the course of mood disorders in adolescents and lead to a better long-term prognosis.

The prevalence of SDB in adolescents is estimated to range from 1-7%, but the data are inconsistent. Major depressive disorders affect 5% to 8% of adolescents, and 40% may be treatment resistant.

Participants in a study (J Clin Sleep Med. 2013:9:1213-1220) were divided into 20 outpatient adolescents with TRD and 20 healthy controls matched for sex and age. The severity of depressive symptoms was rated on the Beck Depression Inventory.

They found that rates of SDB were significantly higher in the TRD group than the control group (50% vs 15%; P=.018), In the TRD group, the number of respiratory disturbances correlated with depressive symptoms.

While more studies are needed to determine the effect that treating SDB has on adolescent depression, in the treatment resistant group, it is recommended that adolescents with depression be screened for sleep disordered breathing early in their care. If you feel your adolescent may benefit from an evaluation, ask your pediatrician about screening for sleep disordered breathing.

You can access a free online screening tool at: www.FloridaSnoringandSleepApneaCenter.com

Sleep Apnea and Pain

Florida Snoring and Sleep Apnea Center, as a team of dedicated practitioners and staff, is constantly working to identify, educate and provide treatment for people suffering from sleep disordered breathing.

The link between chronic pain and sleep disordered breathing is well established.

 

Pain and sleep are integrally connected.  Chronic pain is very common and even more common in people who have poor sleep, and it becomes a vicious cycle.  Pain greatly affects your ability to sleep, and the lack of sleep makes the pain substantially worse.

Pain can be the main reason that someone wakes up multiple times at night, and this results in a decrease in sleep quantity and quality and, on the flip side, sleep deprivation can lower your pain threshold and pain tolerance and make existing pain feel worse.

 

The first step is to figure out if the lack of sleep is contributing to the pain cycle or if the pain is causing a lack of sleep, and then you treat which ever is prevalent.

 

Pain may not be the only problem interfering with your sleep.  Some people may also have an underlying sleep disorder, such as sleep apnea.  Treating an underlying sleep disorder may improve a person’s response to and tolerance of chronic pain. An evaluation to be sure there is no underling sleep disorder is recommended.

 

The first step in making this determination is to take the online sleep survey linked below.  Based on the results, you may need a follow-up home study to determine the severity of your sleep disorder.

 

We would appreciate if you would take a few minutes to complete this survey.

 

 

Thank you.

 

Sleep Hygiene

Sleep hygiene is defined as behaviors that one can do to help promote good sleep quality and quantity.

The importance of sleep:

Sleep is the time your brain uses to reset its own chemical balance. While the mix of chemicals in the brain is quite complex it is easiest to think of them all like liquids in a storage tank. During restful sleep you refill your storage tank. When the tank is full you awaken naturally. During the day you use up your storage tank and as it empties you feel tired and fall asleep.

In the ancient world this is how people lived – based on how they felt – tired or awake.

Today we have modified our daily activities so much that we no longer pay attention to what our bodies are telling us. We get up when we’re still tired, we go to bed when we’re not tired, we stay awake when our bodies tell us to sleep. The cost of this change is feeling poorly. People have an increase in headaches, feel worn out and tired, and lack concentration  As a result, people use stimulants like sugar, caffeine and nicotine to try to keep going when they really need better sleep.

What can we do?:

First – listen to your body. By setting a proper environment for sleep you can assure yourself of both better quantity and quality of sleep. The following are some ideas to help you get the rest you need to feel energetic and happy.

Sleep hygiene tips:

Maintain a regular sleep routine

  • Go to bed at the same time. Wake up at the same time. Ideally, your schedule will remain the same ( /- 20 minutes) every night of the week.

Avoid naps if possible

  • Naps decrease the ‘Sleep Debt’ that is so necessary for easy sleep onset.
  • Each of us needs a certain amount of sleep per 24-hour period. We need that amount, and we don’t need more than that.
  • When we take naps, it decreases the amount of sleep that we need the next night – which may cause sleep fragmentation and difficulty initiating sleep, and may lead to insomnia and sleep deprivation.

Don’t stay in bed awake for more than 5-10 minutes.

  • If you find your mind racing, or worrying about not being able to sleep during the middle of the night, get out of bed, and sit in a chair in the dark. Do your mind racing in the chair until you are sleepy, then return to bed. No TV or internet during these periods! That will just stimulate you more than desired.
  • If this happens several times during the night, that is OK. Just maintain your regular wake time, and try to avoid naps.

Don’t watch TV or read in bed.

  • When you watch TV or read in bed, you associate the bed with wakefulness.
  • The bed is reserved for two things – sleep and sex.

Drink caffeinated drinks with caution

  • The effects of caffeine may last for several hours after ingestion. Caffeine can fragment sleep, and cause difficulty initiating sleep. If you drink caffeine, use it only before noon.
  • Remember that soda and tea contain caffeine as well.

Avoid inappropriate substances that interfere with sleep

  • Cigarettes, alcohol, and over-the-counter medications may cause fragmented sleep.

Exercise regularly

  • Exercise before 2 pm every day. Exercise promotes continuous sleep.
  • Avoid rigorous exercise before bedtime. Rigorous exercise circulates endorphins into the body which may cause difficulty initiating sleep.

Have a quiet, comfortable bedroom

  • Set your bedroom thermostat at a comfortable temperature. Generally, a little cooler is better than a little warmer.
  • Turn off the TV and other extraneous noise that may disrupt sleep. Background ‘white noise’ like a fan is OK.
  • If your pets awaken you, keep them outside the bedroom.
  • Your bedroom should be dark. Turn off bright lights.
  • Have a comfortable mattress.

If you are a ‘clock watcher’ at night, hide the clock.

Have a comfortable pre-bedtime routine

  • A warm bath, shower
  • Meditation, or quiet time

Some who are struggling with sleep regularly find it helpful to print out these recommendations and read them regularly. If you accidentally miss some recommendations, or have a bad night, do not fret. By following these sleep hygiene recommendations regularly, you will help yourself develop a routine that promotes better sleep.

How is Sleep Apnea Treated?

There have been a multitude of theories about what causes sleep apnea. Because of this there have been many treatments proposed as well. The solutions range from surgery on the various tissues in the nose, mouth and throat; to CPAP (continuous positive air pressure) and a very large selection of oral and nasal appliances. Because people vary in their response to treatment, many of these therapies have worked for at least some people. The best treatment is that which keeps the airway open with the fewest negative side effects and risk. Additionally, the treatment must be one which people will use.

 

CPAP meets many of the criteria for success. It opens the airway, has few side effects, has a low risk profile and is readily available. However, many people find the mask, tubes and associated maintenance to be too cumbersome and uncomfortable to use on a daily basis.

 

Surgery, likewise, has its proponents and for some conditions surgery is necessary. For instance, to remove overgrown tissue from the airway or correct malformed jaw bones. Surgery, however,  does not have a low risk profile, can have significant side effects, requires highly specialized skills and must be done in an operating room environment.

 

Oral appliances are suggested as a first line treatment for mild and moderate sleep apnea. Oral appliances can also be effective for severe sleep apnea and are used frequently is patients who don’t tolerate CPAP. Oral appliances require at least a few teeth to hold them in and do put a strain on the teeth and supporting structures. This is usually not significant. We will help with determining if your teeth are strong enough.

 

The key takeaway is that we seek to limit the bad effects of sleep apnea on your health with the fewest treatment side effects. The only way to know how you will respond to treatment is to measure your sleep apnea both before and after treatment. This is done with a home sleep test which records many parameters of sleep during the night. Both the experience in working with different devises and the ability to monitor the results of therapy are the reasons to choose professional help in treating your own sleep disorders.

 

The consequences of poor sleep are serious and substantial. We have a quick, easy and well thought out process to help you. Please contact us.

Why Be Diagnosed and Treated for Apnea by Florida Snoring and Sleep Apnea Centers?

Hi. My name is Dr. Tim Morris and years ago I began my training in sleep medicine when it was realized that an oral appliance could be a successful treatment for many sleep breathing conditions from simple snoring to yes, even severe sleep apnea.

It was clear to us from the beginning, to best diagnose and treat patients, a model that was patient centered needed to be created.

This process had to be easy, quick and simple.

It was also clear this model had to not only include medical sleep specialists, but had to coordinate care between the professions so that the best interest of the patient could be addressed.  And that is exactly what we have done.

Once our patients have been screened with a simple questionnaire, the first step is for them to see a Florida sleep certified physician.  We have made this a simple process.  Our patients schedule their visit with our hand picked top notch physicians who are not only well versed in the science – but committed to including the patient in all decision making where appropriate. 

Your first visit is scheduled at either our Merritt Island or Hibiscus office where our physician will see you via telemedicine. 

If a sleep test is indicated, rather than being sent to a sleep lab to spend the night, a validated sleep test will be provided for you, and this simple test can be quickly done in your own home!  You will be given instructions about the test equipment at your interview visit, but there is also a 24 hour hot line you can call with questions.

The results of that test will then be reviewed with you at a follow up telemedicine visit.  At that visit treatment alternatives will be presented, and your preferences will be considered strongly. It is at this point our extensive training in oral appliance therapy for snoring and sleep apnea will play a major role in your treatment.   If this treatment is indicated and something you would prefer after being given all the information concerning this treatment and others, then plans can be made to start the treatment and the appliance can be constructed and delivered efficiently. 

All your questions will be answered at this follow up visit including your insurance coverage for whatever treatment is recommended. 

We will file insurance for you, including Medicare.

We have made it easy to be seen by a sleep physician, and have assured that the sleep physician you see is patient oriented and not biased towards any treatment.  We have made sure that whatever treatment is recommended, whether it is CPAP, an oral appliance, or anything else, you have a well-trained person guiding you through this process, to help answer your questions and address your concerns.

And, should an oral appliance be indicated, we can assure you that our high level of training will lead to the highest likelihood of long-term compliance and the highest possible efficiency.

We have created a patient centered alternative that helps assure you are properly and easily diagnosed and that the treatment is tailored uniquely for you. We look forward to seeing you in the near future.

A Primer on Sleep Apnea

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain — and the rest of the body — may not get enough oxygen.

Millions of Americans suffer from sleep apnea, but many go undiagnosed and untreated, mainly because some of the telltale symptoms occur during sleep—frequent snoring, gasping for air, silent breathing pauses that can last seconds to minutes. Yet, as NHLBI-funded studies have found, sleep apnea can have severe health consequences over time if left untreated. The disorder has been associated with an increased risk of high blood pressure, heart attack, stroke, obesity, diabetes, and glaucoma. And new findings indicate that pregnant women with sleep apnea have a higher chance of developing high blood pressure and giving birth prematurely. 

The fallout is not just on individuals, but the public at large: because many with the disorder feel persistent sleepiness even after a full night’s sleep, untreated sleep apnea has been associated with lower work performance and a higher risk of while driving and at work.

So, what should the average person know? Here’s a quick primer:

Who’s affected most by sleep apnea? People of all ages, genders, and races suffer from sleep apnea, but African-American males, Asians, Native Americans, and Hispanics appear to have it more, compared to European whites. Excessive weight gain tends to increase the likelihood of getting the disorder, and it affects the severity of the breathing, too. That’s because excessive fat can cause the airway walls to thicken and narrow the inside of the windpipe, making it harder to keep open.  Finally, alcohol, smoking, and certain types of medications, such as opioid pain killers, can interfere with the control of breathing and increase the severity of sleep apnea. 

Are there different kinds of apnea? Yes, there are two main types:  obstructive sleep apnea and central sleep apnea.  Obstructive sleep apnea, the most common, is caused by blockage of the upper airway and results in temporarily impaired airflow during sleep.  This blockage sometimes causes loud snoring, snorting, and gasping, but not everyone who snores has sleep apnea.  Central sleep apnea occurs when the brain fails to send correct signals to your breathing muscles, resulting in breathing stoppage or abnormal breathing patterns. The frequency and severity of this stoppage is classified as mild, moderate or severe after an overnight sleep test has been performed.
 
What should you do if you think you have it? First take the short quiz on Sleep Apnea here.

If you score over 43 points we can arrange an appointment with a certified sleep physician, via telemedicine, in our Merritt Island or Hibiscus offices.

What treatments are currently available to help? No drugs are currently on the market for sleep apnea, but you can take certain steps to help keep the airway open during sleep.  Losing weight, sleeping on your side, and exercising throat muscles can reduce, in some cases, the severity of mild obstructive sleep apnea. The two most common treatments for sleep apnea are CPAP (continuous positive airway pressure) which involves an air pump, hose and mask; and a professionally fabricated oral appliance which keeps the airway open.

Are there other options? Surgery that widens breathing passages and implants that stimulate airway and tongue muscles: All may be recommended by a physician.  

In our next article on sleep apnea, we will discuss the various treatments in detail to give you a broad understanding on which option might work best for you.

At Florida Snoring and Sleep Apnea Center, we work together with physicians, sleep centers and dentists to effectively design and implement an individual treatment plan for you to manage your sleep problem. This is a medical condition and it is covered under your medical insurance. We are providers for major medical plans.

Dr. Timothy Morris has been working successfully with patients like you for over 20 years. He has received extensive training in this field and stays up to date on the latest improvements in sleep medicine.

To schedule an appointment with Dr. Morris, please contact one of the practices below:

Florida Snoring and Sleep Apnea Center
775 E. Merritt Island Cswy, Suite 115
Merritt Island, FL 32952
321-831-2961
Monday – Friday: 9am – 5pm

 

Florida Snoring and Sleep Apnea Center
1390 S Babcock St
Melbourne, FL 32901
321-831-2961
Monday – Friday: 9am – 5pm