Mental Illness and Sleep Disorders
When we deal with patients we try to accommodate all their needs to the best of our ability. Unfortunately it is difficult to deal with issues that patients do not tell us about. The issue may be there, but perhaps the patient does not feel that it is relevant. They may also be embarrassed and so they do not share their anxiety, depression or other mental illnesses with us until they have arrived for the test. In some cases these patients would benefit from one on one care. In other cases a family member staying the night would be helpful.
We have dealt with many disorders, the most common being depression and anxiety. These disorders can make the set up and the paperwork difficult as the patient can sometimes over think what is involved. Tours of the facility and a phone call to go over the paperwork has helped in many cases to ease the worries of the patients and what they could be experiencing.
Pre-CPAP mask trials are also quite helpful, although often it is difficult to convince a patient to come in for one since coming to the facility an extra time can be stressful in itself. As an alternative we tend to bring these patients in earlier to have more time for mask fitting and acclimation. We also have them try on several different masks so they can choose the most comfortable. This ability to have control really does help especially when a situation like sleeping in a lab with a body full of wires makes a person feel so out of control.
In the more difficult disorders such as bipolar and schizophrenia, a family member staying the night is the most desirable. The bad part is that many of the family members see the sleep study as a much needed night off. In situations like this it is great when you have patient technicians working with them. They need a great deal of patients and multiple explanations about what is going on. Sometimes due to the medications they are difficult to understand. It is also when it is especially important to know your medication effects on sleep. This allows you to understand the changes in sleep architecture and possible changes in waveforms that may occur.
I bring all this up because we recently had a week of mental illness. It was not intentional but it did make for an interesting week. We started the week with a patient who came to the lab having taken multiple medications, some of which he did not want his physician to know about. He was quite honest about what he had taken but he also showed what medication effect could be when taken to the extreme.
Next we had a paranoid schizophrenic who came in for a sleep study. He was extremely friendly but he was definitely a one-on-one type of patient. He was difficult to understand and his sleep architecture did show changes due to his medications. He had the additional challenge of having a history of seizures and required an extended montage. I was fortunate that there were two patients that night so I could justify a second technician as I am not sure I would have felt comfortable leaving one technician alone with this patient.
The other thing that really came to our attention the last couple of weeks was that almost every patient we have had is on some sort of antidepressant. This makes me wonder if many patients who are being treated for depression or anxiety may really have a sleep disorder. Is it easier to prescribe a medication than to ask the questions and send them for a sleep study? Are we so sleep deprived that we can not tell the difference between mental illness and being tired?