This post isn't to talk about the wonders of good sleep. You know how a good nights sleep can do wonders. This post is spotting one of the earliest signs something is wrong with someone's mental health. Asking how much they've slept, how well they felt rested relative to the hours spent sleeping, and overall quality of sleep can give me a lot of clues as to what goes on in someone's head.
If someone says they felt energized despite only spending less than 3 hours and they've been having this type of sleeping pattern for a couple of days, I immediately think they're on their manic phase. Provided they aren't on drugs that give some high or other stimulants of course.
If someone says they get less sleep or more sleep but still feel less energy waking up, I think of depression. Provided drugs that cause people to sleep more are ruled out. It's an automated way of thinking, like an algorithm.
If someone says they can't sleep, ask what the cause of that disturbance, for most people with anxiety, they either get worked up about the imagined scenarios. For people that have lost some sense of reality or having problems processing their hallucinations, it might be the images or voices preventing them from getting some rest at night.
Or it could just be as simple as using your smartphone when you're supposed to be practicing good sleep hygiene.
How much have you slept? do you feel rested? do you feel irritable lately? when do you sleep? what keeps you up at night? and all questions related to how people sleep.
Asking about people's sleeping pattern is the most benign and least intrusive opening yet it already gives you plenty of information and even more open ended answers to what's going on with that person.
I have yet to encounter any patient that they themselves haven't noticed or folks noticed about their disturbed sleeping pattern. If there was a symptom that unanimously combines the common mental health problem, it's that people with sleeping problems have some other stuff going on in their heads.
Remember, sleeplessness is a symptom, an effect, not the cause. You can't sleep because you're restless, you're restless because you can't sleep. You are anxious because you can't sleep, you can't sleep because you are anxious. It can be this or other stuff but usually most mental problems echo a disturbed sleeping pattern. It may appear like a cycle by itself but usually there's a trigger to initiate this cycle. A life event, or some prodromal symptom that people took for granted.
That's why one of the questions I ask on follow ups is how was their sleep these days? if there is a relief in symptoms, then most of the other troubling symptoms eventually mellow down. The drugs are working and now there's more room to do psychotherapy. You can't reason out with a disturbed mind. It's not something like, "snap out of it" or "cheer up", you need to condition the mind to be at ease.
A little bit on insight for yourself, if you have poor sleep hygiene, you might consider getting yourself checked up or reexamine what's bothering you mentally and process it.
Thanks for your time.
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Reading this makes me kinda proud about the knowledge I gained researching about mental health haha. I also first thought manic then depression and etc. Kinda like the same satisfaction when a teacher asks you a question and you know the answer lol.
When it comes to sleep, do you also sometimes recommend patients to a sleep doctor and have them tested there? Or you only do that when you think the medicines and other lifestyle changes are not working? Would be interesting to sleep in the lab with all the tech connected on you so you'll see the brain activity that could also be caused by other disorders like narcolepsy etc.
No, a sleep doctor isn't a common specialty and adds costs to the patient. Most have relatively simple sleeping problems.
Most of the problems with compliance stems from patient having a lack of insight, poor judgment, no reliable support system and financial constraints. The financial part can be alleviated with government programs but a patient that doesn't recognize they have a problem or have poor social support system are the hardest to manage.
The EEG tests are done with the Psychology/ Neuro department outside my current scope but it's nice to get some exposure there. I think I'll get that probably 2-3 years from now.
Great blog.
Definitely. Sometimes, it's not 'all in your head'.
I've been dealing with an autoimmune syndrome for almost 40 years. Sometimes, the first thing to go is sleep, before a flare. Once, I stayed up all night, literally without sleep. When I went to the doctor's the next morning, I hadn't slept at all (couple of other minor, telltale symptoms, but nothing remarkable). She gave me a five-day tapering dose of prednisone and the episode was over.
Sound mind, sound body. Sound body, sound mind :)
40 years, can't imagine the amount of life adjustments you have to make just to attain normalcy. It's usually sleep, the first symptom to appear and heralds more mental problems as it stays. As much as possible, we try to treat the cause rather than rely on the meds, there are times when patients tend to be dependent with the meds but can't solve the root of their problem which is constant exposure to stressful situations. Well not many have the financial capacity to "change" their environment like work place so sometimes treatment can be long term.
Actually, once a diagnosis was determined, adjustment was easier. I have systemic inflammation that can affect every organ. This wasn't obvious at first. Back then, some doctors attributed the amorphous, traveling symptoms to a psychological disorder. However, a few seemingly unrelated physical crises helped lead to a diagnosis. If the inflammation is treated, I'm OK. Wakefulness is often the earliest symptom of the inflammation--affects the CNS. In the earliest treatment regimen massive doses (40+) of prednisone were tried. With time, it became evident a much smaller dose does it for me. I'm lucky. The puzzle was solved and I lead a good life. However, to go back to your blog, if you can't sleep, get yourself checked out. Something might be cooking :))
Sleep is such an important piece of the puzzle. Sadly lots of doctors and clinicians don’t spend much time on that but it does have so many other effects!
Another big one is your lymphatic system. If the person isn’t moving around their body enough their lymphatic system can be clogged and lead to all kinds of health issues, with a lot of mental state changes being a common factor! There’s a great podcast that talks about it - Stop Chasing Pain. He did a mental state lymphatic episode a few weeks ago it was really interesting!
@adamada, I paid out 0.746 HIVE and 0.210 HBD to reward 2 comments in this discussion thread.