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psych and sleep?

Discussion in 'Psychiatry' started by guarana, Aug 3, 2006.

  1. guarana

    guarana like a bird on the wire..
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    hi all--
    have been reading this forum for a while but first time posting. i recently did my psych core rotation and loved it. now i'm trying to decide about applying for a psych residency.....i must say the advice on this forum is very helpful!

    anyways, i was wondering if psychiatrists ever do sleep medicine also? i remember that was one thing in neurology that i found very fascinating (i know, i'm weird!!) i think deep down, it's probably related to my deep love for oversleeping :D

    anyways, is this something reserved for fellowship trained neurologists and pulmonologists? sleep seems relevant to a psychiatrist's field of interest and all...

    thanks!
    -g
     
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  3. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    One of my program's recent graduates is now doing a sleep fellowship, so yes, it can be done.
     
  4. watto

    watto Sleek White Pantsuit
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    You can do sleep fellowship out of pulm, neuro, peds, even family practice. I did a fantastic rotation at a regional sleep center and am now considering it as well. The problem is the small number of accredited fellowships, esp. on the West coast.

    One of my favorite topics is REM sleep behavior disorder, which was elucidated by Dr. Carlos Schenk at Minnesota--himself a psychiatrist. 0.25 of klonopin does the trick for these patients like you wouldn't believe.

    And the sleep eating phenomenon with Ambien is simply fascinating. We saw a woman on our PSG videotape mowing down a cup of chili with her bare hands one night...
     
  5. Anasazi23

    Anasazi23 Your Digital Ruler
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    It seems psychiatry is making a big push in sleep medicine. I can't go to a conference, open a journal or read a psychiatry newsletter without some mention of sleep. It fits perfectly in a psychiatrist's domain, since we are so familiar with the sleep meds, and considering how many sleep disorders are medically and psychologically influenced.
     
  6. 50960

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    So what do you prefer, ambien, lunesta, zopiclone (in europe), restoril for primary insomnia?? Also, how do you use remeron, seroquel, rozerem for insomnia with other iss :confused: ues?
     
  7. watto

    watto Sleek White Pantsuit
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    I could have sworn I saw a tramadol-related question that you posted earlier. Anyway, here is a reference to one small study that found its effectiveness in reducing paradoxical sleep:

    Walder B. Tramer MR. Blois R. The effects of two single doses of tramadol on sleep: a randomized, cross-over trial in healthy volunteers. [Clinical Trial. Journal Article. Randomized Controlled Trial] European Journal of Anaesthesiology. 18(1):36-42, 2001 Jan.
    UI: 11270008

    The insomnia question can be answered best by first coming to know what the patient's complaint is--do they have difficulty falling asleep or staying asleep, and discerning the etiology either by hx, sleep diaries +/- actigraphy, or formal sleep study with multiple sleep latency test if excessive daytime sleepiness is thought to be due to a narcoleptic vs idiopathic process. For our patients that had frequent awakenings, temazepam 30 was probably the first-line, due to its half-life; ambien used for those with difficulty falling asleep. Don't get the clinic director started on sustained-release Ambien though, for his money, temazepam was equally effective.
     
  8. 50960

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    Yes, but it interferes with stage 4 sleep thus leave a person eventually sleep deprived. Stage 4 is vital for restoartive sleep, and should not be tampered with in any medical illness especially all there fibromyalgia type folks.
     
  9. Anasazi23

    Anasazi23 Your Digital Ruler
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    Anyone see addiction to Ambien CR yet?

    I used to argue with my attending that I was seeing Ambien addiction a couple years ago. He had a different view. So it became my crusade to post on the local cork-board all the celebrities and clinics opening for Ambien addiction. i.e. Eminem
    :smuggrin:
     
  10. Anasazi23

    Anasazi23 Your Digital Ruler
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    What kind of 'other issues?'

    Psychosis?

    :laugh:
     
  11. 50960

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    No I meant insomnia secondary to anxiety d/o, depression, acute stress etc... Not just primary insomnia. :cool:
     
  12. Psyclops

    Psyclops 1K Member
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    I've noticed an increase in Rx sleep med comercials, which is saying something, they've always been advertised heavily IMO. And I've noticed that they all, or alot at least, have said something to the effect of "In conjunction with lifestyle changes...". I can't help but think that for many a pill would be a last line of defense following behavioral changes, altering of schedule (assuming it's possible), excercise, etc.
     
  13. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    In an ideal world, yes. However, we live in a "pill-as-first-option" culture, and Big Pharma knows it!
     
  14. MBK2003

    MBK2003 Senior Member
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    And yet, in my experience (n=5), CBT for insomnia in 4-5 sessions can make a HUGE improvement in sleep and conveys the message to the patients that they have control over their sleep again.

    Also, another patient I had on the inpatient unit had profound initial and middle insomnia, unrelated to her mood state (profoundly depressed at the time of admission) who came in on 4 sleep meds (Alprazolam 2mg, Seroquel 400mg, Trazadone 200mg, and Remeron) in addition to her antidepressants, whose insomnia resolved completely (8 hr/night, <30 min to fall asleep, no middle insomnia, and NO MEDS) with daily morning light therapy. It was the most profound example I had ever seen of someone with what we never realized was sleep phase delay.

    All of us residents on the unit were jealous that our irregular work schedules and need to be in the hospital by 7am, made it impossible for us to start light therapy ourselves.
     

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