Friday, March 6, 2009

Abnormal Sleep as a Cause of Mental Symptoms

Sleep disorders can be a CAUSE of the brain symptoms being diagnosed as "mental illness."

That seems so logical, except that for years doctors insisted that our children's sleep problems are being caused by the "mental illness." This is true even when we tell them... THE SLEEP ISSUES CAME FIRST(See book)

In our personal experience, just as some endocrinologists refuse to address endocrine issues in patients on psychotropic medications (see here) some neurologists/sleep specialists refuse to do sleep studies or address sleep issues when the patient has a diagnosis of "mental illness." Their reasoning is "Of course you have sleep issues. That's because you have bipolar [schizoaffective, depression... take your pick]" You sometimes have to go through a list of sleep specialists until you find one who is undaunted by the "mental" diagnosis.

Research has been out there backing up our parental observations (here). Although doctors keep saying the mood and psychotic disorders cause sleep disturbance -- many times it is the opposite way around. SLEEP issues came FIRST. But that research has been widely ignored.

Until now.

An article in a popular magazine (New Scientist) has pulled together the latest peer-reviewed research, and interviewed the researchers, to give the general public a better look into this phenomena and to demonstrate a serious lack of awareness and medical knowledge (see article here).

The article starts off with the profoundly obvious:
TAKE anyone with a psychiatric disorder and the chances are they don't sleep well. The result of their illness, you might think. Now this long-standing assumption is being turned on its head, with the radical suggestion that poor sleep might actually cause some psychiatric illnesses or lead people to behave in ways that doctors mistake for mental problems.

The good news is that sleep treatments could help or even cure some of these patients. Shockingly, it also means that many people, including children, could be taking psychoactive drugs that cannot help them and might even be harmful.
THIS was the case with BOTH my kids! Both the bad news (sleep issues and being given antipsychotics to control mood and psychotic disorder instead of addressing the sleep issues) and the GOOD news - that sleep treatments could help (see Sleep: Timing of Melatonin, Light, Dark, and the Use of Other Sleep/Wake Aids)

MANY other parents say the same thing - SLEEP issues came first.

My younger daughter, especially, had severe issues seemingly from birth. In the end, she came off the last of her Seroquel only by addressing sleep issues with an amino acid, Tryptophan, commonly needed in Celiac/gluten sensitivity cases (which my kids also were found to have - a problem shared with many others with a "mental illness" diagnosis). However, she also takes other meds for narcoleptic symptoms in the daytime, and other supplements at night (see here).

I have often wondered WHY narcolepsy medications (such as Xyrem), and other sleep aids, have not been seriously studied for the treatment of the subset of patients with ADHD, depression, bipolar, schizoaffective, and schizophrenia diagnoses--for whom sleep issues are a major component--and perhaps preceded those diagnoses. (See this interesting article: Narcolepsy Presenting as Schizophrenia).

Hopefully, as other researchers pay attention to these articles, more studies will be conducted, and more attention will be paid to a better medical, functional, and holistic approach to these diagnoses.

But no number of studies will help if psychiatrists and psychologists -- who are usually the first medical specialists our children get referred to--do not get the message that the SLEEP may be the CAUSE -- not the effect.

Sleep-disordered breathing (SDB) is linked to psychiatric symptoms and cognitive impairment even in very young children as this article shows: Snoring Linked to Depression and Anxiety in preschoolers:
Preschool-aged children who snore have more symptoms of depression and anxiety, as well as impairments in attention and language skills.

The snoring children were more likely to have other sleep problems, such as nightmares, talking in their sleep, or difficulties going to bed.
It is disturbing to me that my children's psychiatric and physical conditions continued to worsen while they were prescribed antipsychotic medications, which left them with permanent physical damage from side-effects, partially (maybe wholly if it had been addressed early enough?) because of ignorance about addressing SLEEP issues.

For all I know, in my younger daughter's case, a lot of her hormonal and autoimmune problems came from the stress of disordered sleep.

Can you imagine -- my child who had a problem both staying asleep and staying awake, and who had excessive REM, developed "attentional problems" for which she was given a stimulant, which resulted in her sleeping less, which resulted in her becoming acutely psychotic.

I was then told that of course she did not sleep -- she had a psychotic disorder. The psychosis was an escalation of "her illness." Hmmm... and what exactly was that illness? Well... one that labels her new set of symptoms, of course -- one from the DSM -- a label called "schizoaffective."

The acute prolonged psychosis was over a decade AFTER the onset of observable profound sleep symptoms, and almost a decade BEFORE those sleep symptoms were adequately addressed, and she could eliminate the last of her antipsychotic medication.

What a waste. What a shame. And for the most part, the doctors still aren't listening to what we parents are saying about OUR children.

These books may be of interest:


Also, see the book list on "Sleep: A Critical Yet Under-addressed Component of Health"

Related Articles:

Important Research Articles on this topic:

The adverse consequences of sleep disturbance in pediatric bipolar disorder: implications for intervention." Harvey AG  Child Adolesc Psychiatr Clin N Am, 2009 Apr ; 18(2): 321-38, viii.

Narcolepsy in childhood. Nevsimalova S  Sleep Med Review 2009 Apr ; 13(2): 169-80

Longitudinal Association of Sleep-Related Breathing Disorder and Depression" Paul E. Peppard, PhD; Mariana Szklo-Coxe, PhD; K. Mae Hla, MD; Terry Young, PhD Archives of Internal Medicine, vol 16 Sep 2006.

Sleep Disturbance in Bipolar Disorder: Therapeutic Implications" David T. Plante, M.D., and John W. Winkelman, M.D., Ph.D. Am J Psychiatry 2008; 165:830-843

Diagnostic and therapeutic challenges in narcolepsy-related psychosis. Kondziella D, Arlien-Soborg P. J Clin Psychiatry. 2006 Nov;67(11):1817-9.

Schizophrenia and narcolepsy: A review with a case report. Kishi Y, Konishi S, Koizumi S, Kudo Y, Kurosawa H, Kathol RG. Psychiatry Clin Neurosci 2004;58(2):117-124.

Narcolepsy Presenting as Schizophrenia. Farid Ramzi Talih, MD  Innovations in Clinical Neuroscience 2011 April; 8(4): 30–34.

Mania in a Boy Treated With Modafinil for Narcolepsy Am J Psychiatry 162:813-814, April 2005

The human emotional brain without sleep--a prefrontal amygdala disconnect. Curr Biol. 2007 Oct 23;17(20):R877-8 Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP.

Circadian Rhythms Factor in Rapid- Cycling Bipolar Disorder
Ellen Leibenluft, M.D. May 1, 1996 Psychiatric Times. Vol. 13 No. 5

Gene Controlling Circadian Rhythms Implicated In Bipolar Disorder ScienceDaily (Mar. 22, 2007)

Circadian patterns of growth hormone and cortisol secretions in narcoleptic patients.
Besset A, Bonardet A, Billiard M, Descomps B, de Paulet AC, Passouant P. Chronobiologia. 1979 Jan-Mar;6(1):19-31

Metabolic and endocrine effects of sleep deprivation. Copinschi G. Essent Psychopharmacol. 2005;6(6):341-7

Impact of sleep and sleep loss on neuroendocrine and metabolic function. Van Cauter E, Holmback U, Knutson K, Leproult R, Miller A, Nedeltcheva A, Pannain S, Penev P, Tasali E, Spiegel K. Horm Res. 2007;67 Suppl 1:2-9. Epub 2007 Feb 15.

Pediatric sleep apnea: Early onset of the 'syndrome'?

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Last Updated:
18 October 2011

1 comment:

John said...

Thanks for the article , people forget the importance of a good nights sleep , when it come to you mental health ,