CPAP can help adults with sleep apnea and depressive symptoms

Depressive symptoms in adults with sleep apnea are improved when the person uses a CPAP.

A new study shows that depressive symptoms are extremely common in people who have obstructive sleep apnea, and these symptoms improve significantly when sleep apnea is treated with continuous positive airway pressure therapy.

Results show that nearly 73 percent of sleep apnea patients (213 of 293 patients) had clinically significant depressive symptoms at baseline, with a similar symptom prevalence between men and women. These symptoms increased progressively and independently with sleep apnea severity.

However, clinically significant depressive symptoms remained in only 4 percent of the sleep apnea patients who adhered to CPAP therapy for 3 months (9 of 228 patients). Of the 41 treatment adherent patients who reported baseline feelings of self-harm or that they would be "better dead," none reported persisting suicidal thoughts at the 3-month follow-up.

"Effective treatment of obstructive sleep apnea resulted in substantial improvement in depressive symptoms, including suicidal ideation," said senior author David R. Hillman, MD, clinical professor at the University of Western Australia and sleep physician at the Sir Charles Gairdner Hospital in Perth. "The findings highlight the potential for sleep apnea, a notoriously underdiagnosed condition, to be misdiagnosed as depression."

Study results are published in the September issue of the Journal of Clinical Sleep Medicine.

The American Academy of Sleep Medicine reports that obstructive sleep apnea (OSA) is a common sleep disease afflicting at least 25 million adults in the U.S. Untreated sleep apnea increases the risk of other chronic health problems including heart disease, high blood pressure, Type 2 diabetes, stroke and depression.

The study group comprised 426 new patients referred to a hospital sleep center for evaluation of suspected sleep apnea, including 243 males and 183 females. Participants had a mean age of 52 years. Depressive symptoms were assessed using the validated Patient Health Questionnaire (PHQ-9), and the presence of obstructive sleep apnea was determined objectively using overnight, in-lab polysomnography. Of the 293 patients who were diagnosed with sleep apnea and prescribed CPAP therapy, 228 were treatment adherent, which was defined as using CPAP therapy for an average of 5 hours or more per night for 3 months.

According to the authors, the results emphasize the importance of screening people with depressive symptoms for obstructive sleep apnea. These patients should be asked about common sleep apnea symptoms including habitual snoring, witnessed breathing pauses, disrupted sleep, and excessive daytime sleepiness.

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Study: Link between depression and sleep disorders in men

A study found a link between depression and sleep disorders in men.

Sleep problems are often caused by various mental illnesses, such as depression or post-traumatic stress disorder, but a new research shows interchangeability between sleep disorders and depression. Apparently, having trouble sleeping can also be a trigger.

Researchers from the University of Adelaide and the Adelaide Institute for Sleep Health examined levels of sleepiness throughout the day in almost 2,000 Australian men aged between 35 and 83.

It turned out that those exhibiting severe daytime sleepiness had 10 percent more chances of becoming depressed than those who felt rested during waking hours. Even after various risk factors were taken into account, the link between the two held up.

At the beginning of the assessment, none of the men entering the study were diagnosed with severe obstructive sleep apnea, but after joining, 856 of them were examined in the light of symptoms related to the condition.

Those receiving this diagnose turned out to be 2.1 times more prone to become depressed than participants who didn’t have the sleep condition.

According to the results, men who struggled with both extreme daytime sleepiness and severe sleep apnea had even more increased chances of depression – 4.2 times more than men with no sleep disorders. Suffering from both conditions also meant 3.5 times more chances of depression when compared with men with only one of them.

Two follow-up tests were involved in the evaluation of depression levels, taken at a five years difference from one another. This period allowed researchers to observe whether it is possible that sleep disorders are linked to a recent diagnosis of depression.

During those five years, men suffering from severe sleep apnea diagnosed during the study turned out to have 2.9 times increased risk of becoming depressed.

However, the study’s design could not help researchers determine whether sleep problems can be considered boosters of depression risk in men. They believe it is possible that depression is a cause of sleep disorders, but the reverse was more difficult to assess.

The team also considered the possibility that a third factor included in the equation could cause both depression and sleep troubles.

Authors of the study are still unsure about the exact relation between a sound sleep and risk of depression, but the results offer enough information doctors can use in their practices. For example, after a patient receives a depression diagnosis, physicians should order a screening for obstructive sleep apnea, even if the patient doesn’t show signs of sleepiness.

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Premature babies predisposed to depression

A recent study claims that premature babies have a high risk of depression later in life.

People born extremely premature have a significantly higher risk of developing psychiatric problems later in life, a new Canadian study says.

Researchers at McMaster University in Hamilton, Ont., studied 174 people born in Ontario between 1977 and 1982 — 84 of whom weighed less than 1 kg (2.2 lbs.) at birth, and 90 of whom fell into the range of normal birth weight.

The low-birth-weight babies were 2.5 times more likely to develop a mental health problem such as depression, an anxiety disorder or attention-deficit/hyperactivity disorder (ADHD), the study found.

The likelihood is even higher — nearly 4.5 times — for those whose mothers received a high dose of steroids before giving birth.

At the same time, the research found a positive outcome: the low-birth-weight babies were nearly three times less likely to develop an alcohol or substance abuse disorder.

The study was published in the journal Pediatrics.

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Why students need to get enough sleep

This article explains why it is so important for young adults, especially students, need to get enough sleep.

Humans need sleep. Young adults especially need it, and more  of it if possible. While growth spurts may be over, teenaged brains are still developing, and they will not fully mature until a person’s mid-20s, at the least. While students are in school trying to expand their minds, the very structure of their brains is expanding at the same time. Young adults need to balance academics with their sleep, which actually aids in learning and development. It may often seem like these two activities are at odds with each other, but their correlation is important.

Young adults have odd sleeping schedules, and it is not completely their fault. Developing brains of adolescents are wired to go to sleep later. When combined with heavy collegiate workloads, freedom from parental restrictions and the atmosphere of the city that never sleeps, it is no wonder that NYU students often go to sleep extremely late. While late bedtimes alone can be troubling, affecting everything from throwing off our circadian rhythms to our immune systems, this issue is compounded during the winter time. Moreover, students from warmer regions with longer days and shorter nights may not be aware of the effects the winter can have on one’s system. By going to bed late, young adults exacerbate these effects, which can lead to medical issues.

Seasonal affective disorder — a form of depression caused by changes in seasons — is among the potential complications. It can be triggered by a variety of factors, including an unnatural sleep schedule and decreased exposure to light. Symptoms of seasonal affective disorder usually manifest during fall and winter, and deficient sleep during this period can make individuals more vulnerable to depression. Research indicates that going to bed late when the sun sets later is not necessarily problematic. An 11 a.m. wake-up time gives one plenty of sunlight to maintain proper Vitamin D levels and circadian rhythm. Going to bed late when the sun goes down early is a recipe for disaster, however, because an 11 a.m. wake-up time means five hours of sunlight at the most. Students should be wary of seasonal affective disorder and take sleep seriously. Depression in the middle of a semester can jeopardize both academics and social life.

In college, personal well-being is seldom prioritized. This should not be the case — sleep is an essential tool for physical and mental health. Sleeping in late for Palladium brunch rather than waking up to an early breakfast may seem preferable, but a balanced sleep schedule can literally make winter much brighter. Suspend late-night study sessions, close Netflix and go to sleep — your mind and body will be grateful.

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Drinking before pregnancy may indicate behavior problems in children

A study found that women who drink before pregnancy are more likely to have children with behavioral problems.

Risk drinking before pregnancy can increase the risk of the development behavioral problems in toddlers. This comes from a new study using data from the Norwegian Mother and Child Cohort Study (MoBa). Early intervention to help and support mothers and their children could help to prevent these problems from developing into long term behavioral problems.

In the study, several screening questions were used to measure maternal drinking behavior; how many drinks were needed to feel high, had others irritated or hurt them by criticizing their alcohol consumption, had they felt they ought to drink less alcohol, and had they ever drunk alcohol in the morning to relieve a hangover.

The study shows that risk drinking before pregnancy increases the risk of early behavior problems among children. According to the researchers, risk drinking may be due to other associated risk factors in maternal behavior such as anxiety, depression or attention deficit hyperactivity disorder (ADHD), which also are known to have an impact on child behavioral problems.

Prenatal exposure to alcohol is known to affect the developing fetus, with adverse cognitive and behavioral effects. Most risk drinking women therefore limit or stop drinking alcohol while pregnant. Paternal risk drinking is also known to have a negative impact on toddler behavior. This is the first study to study the impact of risk drinking before pregnancy. The results could not be explained by alcohol consumption during pregnancy and after birth.

"This increased risk for behavioral problems in the child is probably not due to the risk drinking per se, but rather to the general mental health and lifestyle of some of the mothers. Risk drinking behavior before pregnancy may indicate that these families could need closer follow-up and support during the early years of the child's life" says Ann Kristin Knudsen, primary author of the article published in the European Child and Adolescent Psychiatry journal.

The study considered both internalizing and externalizing behavioral problems among the toddlers. Internalizing behavioral problems include anxiety, inhibition, withdrawal or depression. Restlessness, defiance, fighting and lack of remorse are examples of externalizing behavior. These are known risk factors for behavior problems in childhood and adolescence, which sometimes continue into adulthood.

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Common issues that hurt your sleep

This article discusses common issues that hurt people's sleep, and tells you what to do about them.

You might remember a time when you could drift off to sleep in an instant and remain in a state of blissful slumber well past lunchtime the next day. Now your sleep is more likely to be lighter and more fitful, and when you wake up in the morning you don't always feel refreshed.

A lack of good-quality sleep could be a natural consequence of changing sleep-wake patterns after menopause. It's also likely that the issue is physical--and fixable. Many conditions can disrupt your rest, and they can be treated. It's important to address these issues. Lack of sleep does more than make you drowsy. Chronic insomnia has been linked to a variety of health problems, including obesity, high blood pressure, heart disease, diabetes and depression.

Go through this list to see whether you might have one of these sleep-stealing conditions. Also check your medicine cabinet. Some medications, including corticosteroids, beta blockers, cold and flu remedies, and certain antidepressants also can interfere with sleep.

1. Sleep apnea

The conventional image of sleep apnea is of the overweight man who snores, but women of any size can also develop these repeated pauses in breathing while they sleep.

"A woman who has a narrow jaw or a change in muscle tone can get apnea," says Dr. Julia Schlam Edelman, clinical instructor in obstetrics and reproductive biology at Harvard Medical School and author of "Successful Sleep Strategies for Women and Menopause Matters: Your Guide to a Long and Healthy Life." Either of these anatomical issues can block oxygen from reaching your lungs (and subsequently the rest of your body) while you sleep. Snoring might not be your main symptom if you do have sleep apnea, but you will notice that you're especially sleepy during the day.

Solution: See a specialist for a sleep study. You may be able to relieve apnea with a few lifestyle adjustments, such as sleeping on your side or losing weight. Your doctor might also suggest an oral appliance or a CPAP machine that blows air into your airways to keep them open at night.

2. Diet

What you eat can affect your sleep. Spicy foods can contribute to painful heartburn. Big meals leave you uncomfortably full, and over time can contribute to obesity--a well-known risk factor for sleep apnea. Too much caffeine could keep you wide awake, even if you finish your coffee in the morning.

"It takes six hours to clear half of the caffeine from your body. If you have enough caffeine, it's still in your body at 4 in the morning," says Dr. Edelman. And though a glass of wine or two with dinner will make you feel relaxed or even sleepy, it won't help you sleep. "You can fall asleep, but once you're asleep you can't sleep deeply," she says.

Solution: Eat dinner at least a couple of hours before bedtime, and keep the meal light. Avoid spicy, fatty foods, as well as alcohol and caffeine. Also, don't drink too many fluids before bed. Having to constantly get up to go to the bathroom can disrupt your sleep, too.

3. Lack of exercise

Sleep and exercise complement each other. Working out regularly can help you sleep better, and conversely, you're more likely to exercise if you get a good night's rest.

Solution: Exercise every day if you can, ideally in the morning. Doing a high-energy aerobic routine too close to bedtime can have the opposite of the intended effect, making you too energized to sleep. A gentle yoga stretch before bed probably won't hurt, though. It might even help you relax.

4. Pain

Arthritis aches or any other kinds of pain don't make for restful slumber. Conversely, a lack of sleep can increase your pain. Researchers believe that a lack of sleep may activate inflammatory pathways that exacerbate arthritis pain. Poor sleep can also make you more sensitive to the feeling of pain.

Solution: In addition to the pain remedies your doctor recommends, try using a heating pad or taking a warm bath before bed to soothe achy joints or muscles. Lying against a body pillow can put you in a more comfortable position while you sleep.

5. Restless legs syndrome

Women are twice as likely as men to have restless legs syndrome (RLS)--a condition that causes a creepy, crawly feeling and uncontrollable movements in the legs at night. It's often linked to hormonal changes early in life and during pregnancy, but RLS can continue as you get older. RLS isn't just miserably uncomfortable--researchers at Harvard have linked this condition to an increased risk for heart disease and depression in women.

Solution: Try simple interventions first. Exercise every day, take a hot bath before bed, massage your legs, and cut back on things that can make you jittery--like caffeine and tobacco. If these measures don't work, your doctor may recommend one of several medicines that reduce RLS symptoms--including ropinirole (Requip), pramipexole (Mirapex), rotigotine (Neupro), or gabapentin enacarbil (Horizant).

6. Depression

"Depression is a common compromiser of sleep, and it's much more common in women than in men," Dr. Edelman says. Women who are depressed may sleep more than usual, but their sleep isn't restful. Some of the antidepressants meant to counteract depression, particularly SSRIs, can also interfere with sleep.

Solution: See your primary care doctor, psychologist, psychiatrist, or therapist for help, which may include medications, talk therapy, or both. If your antidepressant seems to be keeping you awake, ask your doctor to switch you to another drug.

7. Stress

It's impossible to sleep when the weight of the day is pressing on you. Finding a sense of calm before bed isn't easy, especially when you can't unplug from the demands of your day.

Solution: Establish wind-down time. Do a quiet, relaxing activity before bed that doesn't involve a screen. Talk to a friend or family member, sew, or read a real book--not one on a backlit tablet device.

"Just allow yourself to have quiet time," Dr. Edelman adds. And don't sleep with your smartphone on your bedside table.

8. Poor sleep habits

Sometimes insomnia stems from long-ingrained behaviors, like staying up too late or engaging in stimulating activities before bed.

Solution: Follow a few basic sleep hygiene strategies. Go to bed and wake up at the same times each day. Keep your bedroom cool, dark, and comfortable. Use your bed for sleep and sex only. If you can't fall asleep within 15 minutes, get up and leave the bedroom. Read or do another quiet activity for 15 to 20 minutes until you get sleepy.

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Those with Asperger syndrome are more likely to commit suicide

A study shows that those with Asperger syndrome have a higher risk of suicide. This is especially true if they are depressed.

Adults with the milder form of autism known as Asperger syndrome are much more likely to think about and attempt suicide than those in the general population, a new British study suggests.

The survey of 374 British adults with Asperger syndrome found that 66 percent reported having suicidal thoughts and 35 percent had planned or attempted suicide. Suicidal thoughts were much more common among those with a history of depression, the authors noted.

In comparison, rates of suicidal thoughts were 17 percent in the general population of U.K. adults and 59 percent of patients with psychosis, according to the study published June 24 in The Lancet Psychiatry.

Among adults with Asperger syndrome, those with depression were four times more likely to have suicidal thoughts and twice as likely to plan or attempt suicide, compared to those without depression, the investigators found.

The study also found that adults with more severe autism symptoms were more likely to plan or attempt suicide.

"Our findings confirm anecdotal reports that adults with Asperger syndrome have a significantly higher risk of suicide in comparison to other clinical groups, and that depression is a key risk factor in this," study co-leader Dr. Sarah Cassidy, of the Autism Research Centre at Cambridge University, said in a journal news release.

And, study co-leader Simon Baron-Cohen, also of Cambridge, added, "Adults with Asperger syndrome often suffer with secondary depression due to social isolation, loneliness, social exclusion, lack of community services, under-achievement and unemployment."

However, Baron-Cohen believes that "their depression and risk of suicide are preventable with the appropriate support. This study should be a wake-up call for the urgent need for high-quality services, to prevent the tragic waste of even a single life," he said in the news release.

Two experts in the United States weren't surprised by the findings.

Dr. Melissa Nishawala is assistant professor at the Child Study Center at NYU Langone Medical Center in New York City. She said the new study supports "something we have known clinically for quite some time: bright, verbal individuals with autism spectrum disorder (ASD), commonly described as Asperger syndrome, have a much higher rate of depression, suicidal ideation and suicide attempts than peers who are not on the autism spectrum."

Nishawala agreed with Baron-Cohen that the finding "underscores the unmet need for increased support and resources for people with ASD at each developmental stage from childhood through adulthood."

Dr. Alexander Kolevzon, clinical director of the Seaver Autism Research Center at Mount Sinai Hospital, agreed. He said the study "will likely have an impact on patient care by raising clinical suspicion for suicidality [in patients with Asperger syndrome] and highlighting the need for treatment and close monitoring."

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Lifelong changes in brain caused by early life stress

A study shows that stress during early life can cause lifelong effects on the brain.

For children, stress can go a long way. A little bit provides a platform for learning, adapting and coping. But a lot of it — chronic, toxic stress like poverty, neglect and physical abuse — can have lasting negative impacts.

A team of University of Wisconsin-Madison researchers recently showed these kinds of stressors, experienced in early life, might be changing the parts of developing children’s brains responsible for learning, memory and the processing of stress and emotion. These changes may be tied to negative impacts on behavior, health, employment and even the choice of romantic partners later in life.

The study, published in the journal Biological Psychiatry, could be important for public policy leaders, economists and epidemiologists, among others, says study lead author and recent UW Ph.D. graduate Jamie Hanson.

“We haven’t really understood why things that happen when you’re 2, 3, 4 years old stay with you and have a lasting impact,” says Seth Pollak, co-leader of the study and UW-Madison professor of psychology.

Yet, early life stress has been tied before to depression, anxiety, heart disease, cancer, and a lack of educational and employment success, says Pollak, who is also director of the UW Waisman Center’s Child Emotion Research Laboratory.

“Given how costly these early stressful experiences are for society … unless we understand what part of the brain is affected, we won’t be able to tailor something to do about it,” he says.

For the study, the team recruited 128 children around age 12 who had experienced either physical abuse, neglect early in life or came from low socioeconomic status households.

Researchers conducted extensive interviews with the children and their caregivers, documenting behavioral problems and their cumulative life stress. They also took images of the children’s brains, focusing on the hippocampus and amygdala, which are involved in emotion and stress processing. They were compared to similar children from middle-class households who had not been maltreated.

Hanson and the team outlined by hand each child’s hippocampus and amygdala and calculated their volumes. Both structures are very small, especially in children (the word amygdala is Greek for almond, reflecting its size and shape in adults), and Hanson and Pollak say the automated software measurements from other studies may be prone to error.

Indeed, their hand measurements found that children who experienced any of the three types of early life stress had smaller amygdalas than children who had not. Children from low socioeconomic status households and children who had been physically abused also had smaller hippocampal volumes. Putting the same images through automated software showed no effects.

Behavioral problems and increased cumulative life stress were also linked to smaller hippocampus and amygdala volumes.

Why early life stress may lead to smaller brain structures is unknown, says Hanson, now a postdoctoral researcher at Duke University’s Laboratory for NeuroGenetics, but a smaller hippocampus is a demonstrated risk factor for negative outcomes. The amygdala is much less understood and future work will focus on the significance of these volume changes.

“For me, it’s an important reminder that as a society we need to attend to the types of experiences children are having,” Pollak says. “We are shaping the people these individuals will become.”

But the findings, Hanson and Pollak say, are just markers for neurobiological change; a display of the robustness of the human brain, the flexibility of human biology. They aren’t a crystal ball to be used to see the future.

“Just because it’s in the brain doesn’t mean it’s destiny,” says Hanson.

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Link between insomnia and depression

This article discusses the link that exists between insomnia and depression.

We all have times when we feel blue. And there are nights when we just can’t sleep. But it seems that depression and insomnia are closely intertwined, exacerbating each other’s symptoms and complicating treatment.

Insomnia has long been viewed as a symptom of depression. At least 80 percent of depressed patients have trouble falling or staying asleep. An additional 15 percent report they sleep too much. Doctors believed that treating the depression would alleviate sleep problems at the same time.

New research indicates that curing insomnia may make depression treatments more effective. A study conducted by Colleen Carney at Ryerson University in Toronto found that 87 percent of subjects who resolved sleep issues using biweekly talk therapy also saw their depression improve after eight weeks of treatment. That’s twice the success rate of the subjects who didn’t better their sleep.

In 2008, Rachel Manber of Stanford found that 60 percent of patients receiving seven sessions of talk therapy plus an antidepressant fully recovered from their depression, compared to 33 percent who received the same medication and sleep hygiene counseling alone.

The kind of therapy used in these experiments is called cognitive behavioral therapy for insomnia, or CBT-I. The therapist instructs clients to establish and adhere to a regular sleep schedule, to get out of bed during periods of wakefulness, to avoid eating or use of electronics in bed and to eliminate daytime napping.

Insomnia may even predict the onset of depression. Sleep researcher Michael Perlis, Ph.D., has shown that sleep disturbances precede episodes of depression by about five weeks. And sleep disorders intensify over the course of a new depressive episode or relapse.

According to Perlis, associate professor of psychiatry and neuroscience at the University of Rochester, disordered sleep sets off a chain of disruptive symptoms that leads to fatigue, irritability, confusion and loss of memory, disinterest in social activities and lack of pleasure.

The subsequent sleep loss makes people more susceptible to depression and increases the likelihood of further episodes.

The good news is that both disorders are treatable regardless of which causes the other. The first step is to get a proper diagnosis in order to embark on the appropriate path.

ELIMINATING INSOMNIA

The National Sleep Foundation offers the following suggestions for overcoming insomnia:

• Keep a sleep diary. Include all pertinent data, such as the time you go to bed, number of times you wake up during the night, medications taken, amount of caffeine consumed during the day, number of naps and time spent exercising. You’ll quickly notice which actions support good sleep behavior and which ones cause disruptions.
• Eat light meals early in the evening. Heavy meals can cause discomfort. Spicy food may lead to heartburn.
• Steer clear of alcohol. Although alcohol is a sedative and may initially help you fall asleep, it disrupts sleep later in the night.
• Learn to relax. One simple technique is to lie quietly on your bed and systematically tense and relax various muscle groups in your body. You may also practice deep breathing, guided imagery or meditation.
• Evaluate your room. Make sure you have a clean, comfortable, quiet and dark sleep space. Use a sound machine or fan to block unwanted noise. Install blinds to close out streetlights and morning light.
• Wind down. Your body needs time to shift into sleep mode. Devote the hour before bedtime to calming activities, such as reading or taking a warm bath. You’ll be mentally and physically calmer. Your actions will signal your brain that it’s time to go to bed.
  
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Study: Epilepsy patients who don't take medication may become depressed

A study claims that epilepsy patients who do not take medication may become depressed, which can reduce their quality of life.

A new study led by Alan B. Ettinger, M.D., M.B.A., Director of the Epilepsy Center at Neurological Surgery, P.C. (NSPC), has found that many patients who fail to take their antiseizure medications are suffering from depression. Previous studies by Dr. Ettinger and others have found a high incidence of depression in people with epilepsy, but this is the first research to show a direct link between depression and medication nonadherence. The study will be published in the July 2014 issue of the journal Epilepsy & Behavior, and is available online ahead of publication.

"Our previous studies have shown that there are substantial consequences to missing doses of antiepileptic medications, even occasionally," said Dr. Ettinger. "We have also seen that depression impacts quality of life. Now we see that depression is a significant factor in drug nonadherence. This demonstrates that it is critical for physicians to screen their patients for depression, and to talk with them about the importance of taking all of their medications when scheduled."

Missing even one dose of an antiepileptic drug can cause breakthrough seizures, even in patients whose epilepsy is well controlled by medications. This can have devastating effects -- including hospitalizations, falls and related injuries, and even death. Studies have shown that 30-50% of people with epilepsy don't adhere to their medication regimen.

"Other studies have shown a link between depression and failure to take medications in conditions such as hypertension and HIV, but little was previously known about the potential impact of depression on antiepileptic drug adherence," said Dr. Ettinger.

Among other factors thought to play a role in antiepileptic drug nonadherence are memory difficulties and medication side effects.

In the current study, researchers accessed a nationwide health plan/pharmacy database, and selected a sample of 10,000 epilepsy patients. 2,750 patients were randomly selected from this group and mailed an in-depth survey that included a number of validated questionnaires on medication adherence, depression status, seizure severity and frequency, and quality of life, among other factors. Questionnaires used in the survey included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), which asks questions that are highly specific to epilepsy and is considered highly reliable. 465 patients completed and returned the survey. Claims data were analyzed with the widely used medication possession ratio (MPR), to measure drug adherence. (MPR represents the proportion of time that an individual was theoretically in possession of a medication.)

The researchers conducted a path analysis, a highly reliable and sophisticated type of statistical modeling, to determine the relationships between depression, drug adherence, seizure severity and quality of life. One key finding was that depression, as determined by the NDDI-E, was significantly correlated with an elevated risk of antiepileptic drug nonadherence. Depression, as measured by the NDDI-E and another survey instrument, was also associated with low quality of life scores. In addition, patients with depression were more likely to report having more severe seizures.

"We have known for a while that depression impacts patients' quality of life, and we know that it can be treated; now we know that there is a direct link to patient harm," said Dr. Ettinger, who works on a number of committees through the American Epilepsy Society to educate clinicians on the importance of depression screening.

Dr. Ettinger suggests that neurologists inquire about each patient's mood and quality of life, as well as medication adherence, during office visits. There are also brief questionnaires that patients can complete in the waiting room to indicate potential mental health issues. He also points out that some antiepileptic medications are now available in once-daily formulations (making it easier for patients to remember to take them), and that there are other medication adherence reminders now available, including smartphone alarm apps.

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Autism in adults leads to many health problems

This article discusses how autism in adults can result in many other health problems.

Autism apparently isn't a stand-alone disorder, with new research revealing that adults with autism often face a host of mental and physical illnesses.

Kaiser Permanente researchers found that nearly all medical conditions are significantly more common in adults with autism spectrum disorders than those without, ranging from depression to gastrointestinal problems to obesity. Notably, however, adults with autism are much less likely to smoke or use alcohol than other adults, and cancer rates are similar.

"Some of these conditions we've seen in children with autism, so we expected higher rates of anxiety and depression, and some of the medical disorders, such as gastrointestinal disturbances, in adults," said study author Lisa Croen, director of the Kaiser Permanente Autism Research Program in Oakland, Calif.

"That's been reported for a long time in children, so we're not surprised to see those continue to be elevated," she added. "But we were surprised by the magnitude of what we found."

The study is scheduled to be presented Thursday at the International Meeting for Autism Research in Atlanta. Research presented at scientific conferences typically has not been peer-reviewed or published and results are considered preliminary.

Diagnosed in about 1 in 68 American children, autism spectrum disorder is the fastest-growing serious developmental disability in the United States, according to the advocacy and research organization Autism Speaks.

The disorder can be mild or severe, but symptoms typically include social and communication difficulties and repetitive behaviors.

Croen and her colleagues examined medical records from 2008 to 2012, and compared the prevalence of psychiatric, behavioral and medical diagnoses among 2,100 adults with an autism spectrum disorder to 21,000 adults without the disorder.

Adults diagnosed with an autism spectrum disorder had markedly higher rates of mental health problems than the other adults:

• Depression (38 percent versus 17 percent)
• Anxiety (39 percent versus 18 percent)
• Bipolar disorder (30 percent versus 9 percent)
• Suicide attempts (1.6 percent versus 0.3 percent)

People with autism spectrum disorders were also more likely than adults without the disorder to have physical ailments, such as:

• Diabetes (6 percent versus 4 percent)
• Gastrointestinal disorders (47 percent versus 38 percent)
• Epilepsy (12 percent versus 1 percent)
• Sleep disorders (19 percent versus 10 percent)
• High cholesterol (26 percent versus 18 percent)
• High blood pressure (27 percent versus 19 percent)
• Obesity (27 percent versus 16 percent)

"What the data show is really an extension of what we've learned already of children and adolescents with autism," said Dr. Paul Wang, senior vice president and head of medical research for Autism Speaks, who wasn't involved in the study. "It's not just a brain disorder -- it's really a disorder that affects the whole body. And this shows that these problems don't go away."

Croen said that many possible reasons exist for the wide gap in mental and physical ailments suffered by adults with autism, including a potential genetic basis. But the "core impairments" of those with autism -- such as communication problems and heightened sensitivity to touch -- can also make it difficult for them to be properly examined by clinicians, she said.

"People with autism often have very selective eating and their nutrition suffers," Croen added. "Their social impairments can lead to isolation, which leads to a lack of exercise. So some lifestyle factors can create more unhealthy lifestyles."

Social isolation may also explain why adults with autism are less likely to drink alcohol or smoke, noted Croen, also a senior research scientist at Kaiser Permanente Northern California Division of Research.

"Smoking and drinking are more social behaviors, especially in young people," she said. "Or, that's how it gets started. These young people with autism are out of the mainstream."

Croen and Wang agreed that autism researchers should extend their focus beyond the brain to multiple bodily systems as well as examine the transition from pediatric to adult health care.

"I hope these findings raise awareness among the medical community and others that adults with autism have a really high burden of medical and psychiatric conditions, much more than people think," Croen said. "There's a real need for doctors to be educated about autism and the characteristics of these adults so they can provide adequate and effective care."

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Nightmares and insomnia can make depression worse

This article discusses the link between nightmares and insomnia, and how they can make depression worse.

Nightmares can cause difficulty both to sleep and to our waking lives. Intense and distressing dreams often lead to waking at night and can create anxiety about returning to sleep. Nightmares also can have an impact on our moods the next morning, bringing anxiety and difficult emotions into the waking day. New research suggests that nightmares also have an aggravating effect on symptoms of depression, and in combination with insomnia may significantly exacerbate the severity of the mood disorder.

Researchers at Japan's Tokyo Medical University investigated the influence of nightmares on depression, both independently and in conjunction with insomnia. They found the presence of nightmares associated with aggravating effects on depression. They also learned that the joint presence of insomnia with nightmares had a significant effect on the severity of depression.

The study included 2,822 adults, all of whom were residents of a rural community in Japan. The average age of participants was 57. All participants responded to questionnaires regarding their sleep habits and sleep quality, as well as the presence of nightmares and their frequency. Participants also answered questions to evaluate the presence and severity of depression. Researchers' findings indicate that while both insomnia and nightmares influence depression, when they exist together their influence is particularly strong:

• Among the 2,822 adults in the study, 25.5 percent had insomnia. 
• Of the total participants, 4.6 percent experienced nightmares one or more times per week. 
• Nightmares were present much more often in people with insomnia than without. Among participants with insomnia, 70.7 percent also had nightmares, compared to 29.3 percent of participants without insomnia. 
• Both insomnia and nightmares were linked individually to higher scores for depression, indicating more severe versions of the disorder. 
• When insomnia and nightmares were both present, depression severity was rated even higher, indicating a compounding effect of the two sleep problems.

Interestingly, researchers found that the severity of depression was no worse among people who experienced nightmares three or more times in a week, compared to people who reported having nightmares one or two times weekly. This suggests that it is the presence of nightmares at an even modest degree, as opposed to the frequency of the nightmares, which may exacerbate depression.

Nightmares remain a relatively little understood phenomenon of sleep. But we have seen recent research that explores the neurological activity that takes place during disturbed dreaming, as well as investigations of the possible neurocognitive functions behind nightmares and bad dreams.

A recent study explored the often provocative and frightening content of disturbed dreams, as a way to further understand the purpose and the impact that these dreams have on our sleep and our waking lives. There is also a body of research that links the presence of nightmares to more severe depression and anxiety as well as to increased risk of suicide among people with depression:

• Among patients with major depression, nightmares may increase the likelihood of suicide attempts, according to research. In a group of people diagnosed with major depression, those who had attempted suicide one or more times had significantly higher rates of both nightmares and insomnia.

• Another study examining the link between major depression and nightmares found that patients with major depression who reported frequent nightmares were more likely to be identified as suicidal than people who suffered major depression not accompanied by nightmares. Women with major depression and nightmares were found to be at particular risk for suicidal tendencies.

• Other research also indicates women may be especially vulnerable to the influence of nightmares on depression. Scientists in Estonia studied anxiety and depression in relation to sleep problems among a group of medical students. They found among female students an association between the presence of nightmares and both anxiety and depression. No similar link between nightmares, anxiety, and depression was found in male students.

We have a great deal more to learn about nightmares and other forms of disturbed dreaming, and how they may complicate and heighten the risk of mood disorders such as depression. We've seen some important recent breakthroughs in treatment for depression that highlight how important a role sleep play in the course of depressive illness, and in its treatment:

• Recent research indicates that a drug used to treat the sleep disorder narcolepsy may have benefits for depression when used in combination with other medication. Modafinil, a drug used to treat narcolepsy, has shown promise in easing the severity of depression when used in conjunction with anti-depressant medication. This treatment combination also raised rates of remission from depression.

• A federal study on sleep and depression -- the first of several to be released on the topic -- found that treating insomnia in people with depression may as much as double the likelihood of recovery from the mood disorder.

Achieving a deeper understanding of sleep and its impact on mental health may soon be changing the way we treat depression and other mood disorders. Just as sleep is now recognized not only as a symptom of depression but also a contributor to the illness, we may also find that nightmares exist as both a consequence of depression and a factor in its development.

Recognizing the specific risks that the presence of nightmares may pose -- on their own and in combination with other symptoms of disrupted sleep -- can help better identify people who are at higher risk for more aggravated and more dangerous forms of depression. And that could bring us one important step closer to getting people the help they need.

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Botox helps those with depression

A study shows that depressive symptoms are improved by Botox injections.

"Study author M. Axel Wollmer, a psychiatrist at the University of Basel in Switzerland, believes the treatment “interrupts feedback from the facial musculature to the brain, which may be involved in the development and maintenance of negative emotions.” Past studies have shown that Botox impairs people's ability to identify others' feelings, and the new finding adds more evidence: the muscles of the face are instrumental for identifying and experiencing emotions, not just communicating them." JR

In the largest randomized, double-blind, placebo controlled study to date on the effect of OnabotulinumtoxinA (as known as Botox) on depression, researchers found that more than half of subjects suffering from moderate to severe depression showed a substantial improvement (greater than or equal to 50% of baseline) in their depressive symptoms as measured by the MADRS scale.

The study, conducted by Dr. Eric Finzi, MD, PhD and Dr. Norman E. Rosenthal, MD and published in the Journal of Psychiatric Research, included 74 depressed subjects injected with a single treatment of either onabotulinumtoxinA (OBA) or a placebo to the corrugator and procerus muscles between the eyebrows. Results showed that depressive symptoms (as assessed by the MADRS scale) in the OBA treatment group decreased 47 percent after six weeks, compared to 21 percent in the placebo group. This study is the first to show a significant difference in remission rate with OBA in depressed patients (27% OBA vs. 7% placebo).

Study co-author Dr. Norman E. Rosenthal, MD, Clinical Professor of Psychiatry at Georgetown Medical School, commented, "This research is groundbreaking because it offers those who suffer from depression and their doctors an entirely new approach to treating the condition -- one that doesn't conflict with any other treatments."

The study showed that Botox may help relieve depressive symptoms both as a stand-alone and an adjunctive treatment.

"This new research supports earlier facial feedback theory of Charles Darwin and William James which suggests that facial expressions influence mood," added Dr. Eric Finzi, Dermasurgeon and co-author on the paper that first reported that inhibition of frowning by facial injection of OBA could help depressed patients in a pilot study published in 2006.

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Risks of sleep apnea - stroke, heart attack, pneumonia, dementia.

This article discusses the risks associated with untreated sleep apnea. My only comment for this article  is that "Sleep hygiene" does NOT treat sleep apnea. - JR

Sleep Apnea: The Real Risks Involved

Subscribe FreeBy Mike Tuttle · March 27, 2014 

"18 million Americans suffer from it. It can lead to both physical and psychological problems. Perhaps you, as many do, have it and aren’t even aware of it.

Sleep apnea is a sleep disorder that is characterized by snoring and pauses in breathing at night, waking the person momentarily before they fall back asleep. This disruption of sleep can occur several times a night, 5 to 30 times or more in just one hour. A person, both adults and children alike, can suffer from this disorder for years, even decades, before realizing it.

Studies have shown that sleep apnea can lead to problems like irritability, daytime fatigue, depression, hypertension, heart attack, and stroke, but recent studies have shown that the risks are actually more serious than, well, a heart attack. And while obesity can lead to this disorder, the disorder itself can lead to obesity.

The authors of a review posted in The Lancet Diabetes & Endocrinology journal wrote, “Metabolic health … is largely dependent on behavioral factors such as dietary habits and physical activity. In the past few years, sleep loss as a disorder characterizing the 24-hour lifestyle of modern societies has increasingly been shown to represent an additional behavioral factor adversely affecting metabolic health.”

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“Our findings show that sleep apnea is an independent risk factor for incident pneumonia,” theysaid. “Our results also demonstrated an exposure-response relation in patients with more severe sleep apnea may have a higher risk of pneumonia than patients with sleep apnea of milder severity.”

Heart disease, dementia, diabetes … the negative effects continue to mount up. However, along with the worrisome research comes some hope.

Continuous positive airway pressure devices, or CPAP machines, are currently the most common treatment out there. They consist of a plastic facial mask, which the patient wears at night, connected by a flexible tube to a small bedside machine. Using air pressure, it keeps the patient’s airways open during sleep.

“We know that obstructive sleep apnea is a potential cause of high blood pressure, and we know that CPAP use is associated with reductions in blood pressure in people with hypertension,” sayssleep specialist Vishesh K. Kapur, MD. “And now there is reasonable evidence that this treatment can prevent high blood pressure in patients who don’t already have it.”

Modern CPAP machines also come with a built-in humidifier to help prevent dryness in the throat/nasal passages."

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