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THE RELATIONSHIP BETWEEN MENTAL ILLNESS AND SLEEP

Posted on April 19, 2019 at 12:05 PM Comments comments (71)
Poor sleep is both a symptom and a cause of mental illness. Sleep problems may contribute to the development or prolongation of mental illness by making it more difficult to cope with mental problems.

Sleep disorders are comorbid with many other illnesses; the most common comorbidities with insomnia are mental illnesses. It’s estimated that 40% of insomnia patients and over 45% of hypersomnia patients have a psychiatric condition. On the other hand, people without mental illness have substantially lower rates of insomnia.  It’s a striking enough difference that nobody doubts the tie between sleep disorders and mental illness any more.

When it comes to the sleep they do get, people with mental illness often report that it’s not restorative. They wake up still feeling tired, whether from waking frequently during the night, falling asleep too late, or waking too early. In fact, as we’ll go into in the sections below, many studies show that patients with mental health disorders experiences demonstrable changes to their sleep architecture. Often, the individual spends more time in the lighter, less restorative stages of sleep, and less time in the critically important deep and REM stages of sleep.

Insomniacs on the whole tend to suffer from this problem – getting less sleep overall and spending insufficient time in the deeper parts of sleep. This is what makes the disorder so particularly frustrating: they feel like there is no relief from their discomfort.

This lack of sleep in turn makes it more challenging to cope with the symptoms of their mental illness. The REM stage of sleep provides us with the emotional and cognitive benefits of sleep. With sufficient REM sleep, we feel emotionally balanced, and able to regulate our emotions and make good judgments. Our brain works and processes information as it should. Without it, we’re moodier, prone to irrationality and poor decision-making, and have difficulty remembering things. It’s easy to see how this mindset makes it tough to cope with mental health.

Together, mental illness and insomnia exacerbate the effects of each other, creating a classic negative feedback loop, and once they get started, push the patient in a downward spiral. This makes treatment of both conditions difficult.

Left untreated, the sleep problems associated with mental health disorders can be particularly dangerous. A University of Michigan study found a strong correlation between insomnia and suicide.

CURBING PHYSICIAN SUICIDE RATES BY CHANGING THE CULTURE OF MEDICINE

Posted on December 9, 2018 at 2:20 PM Comments comments (65)
What do we know about physician suicide, and how can we prevent this tragedy?

Firstly, we know that physicians are at a higher risk for suicide than the general population.  The Kaiser Family Foundation estimates that there are 968,000 active physicians in the US in 2018.  About 35-40 percent of them are female.  The American Foundation for Suicide Prevention estimates that 300-400 US physicians commit suicide each year, including about 150-200 of each gender.  The total number is likely an underestimate as it is well known that some possible physician suicides end up not being recorder as such.

The suicide rate for female physicians in particular is markedly elevated, with a relative risk of 2.27 compared to US women in general, while that if male physicians is also above the US national average with a relative risk of 1.4.  The fact that physicians are more likely t kill themselves than non-physician equivalent adults in the general population is hardly surprising, as physicians have the  knowledge and skills to make sure that they are successful in a suicide attempt.

Secondly, we know that risk factors for suicide in the general population include major depression or other mood disorders, substance abuse, adverse life events, access to lethal means, medical illness, a family history of mental illness, age (50 or older), and gender (male more common overall).  e also know that in their lifetime, approximately 15 percent of physicians will develop a substance use and/or a mental health-related condition (usually depression or anxiety) that could potentially impair their ability to practice medicine, and that 30-50 percent of physicians at some stage exhibit symptoms of burnout, which may lead to anxiety, depression or substance use disorder.

Thirdly, we know that physicians look after themselves inadequately.  They rarely report depression or suicidal ideas, suffering in silence, or attempting to treat themselves, such is the stigma of psychiatric disorder, even among physicians.  These behaviors are embedded in the medical subculture, which encourage denial and self-reliance, and are at least partly learned implicitly during training.

Why is this happening and what can we do?  There are any possible intervention to reduce this tragedy.  These range from the need for organizational and systemic work changes to reduce administrative requirements and tame electronic medical records to personal and lifestyle changes to aid resilience and reduce burnout, including learning how to better recognize at-risk colleagues.  Some like myself, argue that the Triple Aim of healthcare (improving the patient experience of care, including quality and satisfaction, improving the health of populations, and reducing the per capita cost of health care) should become the Quadruple Aim with the fourth aim being improving the work life of health providers.

The National Academy of Medicine is very active in this field, and has set up an impressive well organized and resourced Action Collaborative on Clinician Wellbeing and Resilience (See https://nam.edu/initiatives/clincian-resilience-and well-being).  This is an excellent website to visit for all interested in this topic.  The American Medical Association, like several other colleges and professional associations, is also committed to this issue and has created five excellent modules in their nine "step forward" program on physician health and wellbeing that are replete with good practical examples of how to reduce levels of burnout and improve organizational and individual responses to stress.

AUTISM SPECTRUM DISORDER AND SLEEP DISORDERS

Posted on August 15, 2018 at 11:39 AM Comments comments (65)
Autism spectrum disorder (ASD) is a catch-all for autism, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. 

ASD affects about 2 million individuals in the United States, and is 4.5 times more common in boys than in girls.ASD affects individuals to different extents. Individuals with ASD can be highly gifted or mentally challenged, but all have some challenges with socializing and communicating with others. Developmental issues associated with ASD are typically diagnosed in early childhood, but can be noticed as early as 18 months.

Between 44 to 83 percent of children with autism spectrum disorder also experience sleep issues. Most commonly, children with autism have difficulty falling asleep and experience disturbed sleep once they do. Problematically, their sleep problems tend to exacerbate other issues characteristic of the disorder. For instance, daytime sleepiness from lack of sleep often results in hyperactivity, inattentiveness, and aggression during the day.

Common sleep disorders affecting children and adults with autism

In general, children with autism tend to sleep 32.8 minutes less per night and take almost 11 minutes longer to sleep than their typically developing peers. Children with ASD also have a higher prevalence of sleep issues than their typically developing peers. One study reported the following instances of sleep issues in autistic children:

  • 54% displayed resistance to bedtime
  • 56% experienced insomnia
  • 53% suffered from parasomnias, such as sleepwalking or night terrors
  • 25% experienced sleep disordered breathing, including sleep apnea
  • 45% had difficulty waking up in the morning
  • 31% experienced daytime sleepiness

Common sleep issues for people with autism include:

  • Sleep-onset insomnia describes difficulty falling asleep. Children with autism are two to three times more likely to have insomnia than their typically developing peers. Children with ASD are also more likely to have anxiety or depression, which are co-morbid conditions of insomnia.
  • Sleep apnea is a form of sleep-disordered breathing where the individual literally stops breathing during sleep for up to a few seconds. Obstructive sleep apnea (OSA) is caused by blocked airways that decrease oxygen levels in the blood. Individuals with OSA experience less restful sleep because the apnea episodes rouse them.
  • Sleepwalking, like autism, is more common in boys than in girls. Sleepwalking episodes typically occur during deep sleep in the first half of the night.
  • Children who sleepwalk are also more likely to experience nightmares or night terrors, sudden rousing during the first half of the night accompanied by sweating, rapid heart rate, fear, and confusion.
  • Rhythmic movement disorder describes rhythmic head or body rocking episodes of 15 minutes or less that occur while the person is falling asleep or just after they fall asleep.
  • Restless leg syndrome (RLS) describes an uncontrollable urge to move the lower limbs in order to relieve a tingling sensation while falling asleep. RLS is more common in women than in men.
  • Bedwetting (nocturnal enuresis), while common enough during early childhood, is even more common in children with ASD than their typically developing cheers.
  • Hypersomnia is the opposite of insomnia, and describes excessive sleep of 10 hours or more that isn’t refreshing and leaves the individual tired during the day.

In addition to the sleep disorders above, children with ASD are also more likely to have epilepsy or gastrointestinal problems, both of which can further disrupt sleep.

Unfortunately, when autistic children have sleep issues, they also tend to be more intense than typically developing children. Worse, short sleep duration is highly correlated with social impairment, especially the ability to develop peer relationships, according to recent research.Sleep-deprived children with ASD see decreased IQ scores, and tend to engage in repetitive behaviors and compulsive rituals more often. They also have higher rates of behavioral issues, depressed or anxious mood, and problem paying attention in school.

Why are children with autism more prone to sleep problems?

While scientists still don’t know why children with autism are more prone to sleep issues, they have advanced a few theories.

Abnormal melatonin production

One theory is that children with autism have brain abnormalities that affect their ability to regulate sleep. Children with autism tend to have abnormal levels of tryptophan, which is an amino acid involved in melatonin production. Melatonin is the hormone responsible for regulating sleep. Autistic children don’t produce melatonin at the same time other people do, so their levels are higher during the day and lower at night – which is the reverse of when it should be.

Difficulty reading social cues

Autistic children have difficulty reading social cues. As a result, they may not correctly interpret the actions of their siblings, parents or other family members getting ready for bed. Besides our circadian rhythms, social cues also help us recognize when it’s time for sleep, especially in early development.Heightened sensitivityBecause children with autism have heightened sensitivity, it can be more challenging for their brain to calm down enough to fall asleep. Plus, they are more prone to be roused by external stimuli during the night, such as a snoring family member or a parent opening a door elsewhere in the house.

Developmental issues

During infancy and as toddlers, typically developing children sleep throughout the day and wake up to feed. As they age, children continue taking naps but sleep less during the day and sleep more during night, until they eventually sleep primarily at night. Young children with autism may not develop mature sleep patterns at the same rate of their peers, which can cause them to wake more frequently during the night and to be more tired during the day.

Genetic abnormalities

Children with autism may experience spend 8 to 10 percent  less time in REM sleep, which is the critically restorative stage of sleep where dreaming occurs and the brain processes memories and learnings from the day. The reduced REM sleep can negatively impact autistic children’s cognitive performance in school and stymie their development.

Researchers hypothesize neurotransmitter abnormalities in the brain may responsible for the reduced REM sleep. They are also currently researching whether a single genetic mutation could cause both insomnia and autism.

How do sleep issues change as my autistic child ages?

Fortunately, many sleep problems affecting autistic children naturally go away with childhood, including night terrors, sleepwalking, and rhythmic movement disorder (RMD).

Night terrors are more common in children during the ages of 3 to 7. Unfortunately, there is no treatment for these, but reassuring your child before bed and whenever they wake up may help calm them.

Children also outgrow sleepwalking, although a 2012 Stanford study estimates 3.6 percent of adults have slept walk within the past year. While you wait for your child to outgrow it, protect against them getting hurt by picking up the floor, clearing clutter, and locking doors and windows.

Most cases of RMD go away naturally by age 5. If you notice your child rocking, do not wake them up as it will cause them to just restart the process when they go back to sleep (unless, of course, your child is about to hurt themselves by falling off the bed). Until then, invest in padded bed rails and floor pads to protect your child from injury.

Adults with ASD have significantly fewer sleep problems than children with ASD, but they still experience them at twice the rate of the general population. About 20 percent of adults with ASD have a diagnosed sleep disorder such as sleep apnea, and insomnia can continue into adulthood for autistic individuals. Adults with ASD also have higher rates of psychiatric disorders and other medical conditions, many of which can contribute to or exacerbate sleep issues themselves.

How can I help my autistic child sleep better?

Autistic children who get a better night’s sleep tend to have fewer behavioral problems and better social interactions, according to a 2006 study published in the journal Sleep. If your child has difficulty sleeping, wakes frequently during the night, or wakes up early, they may have a sleep issue. Monitor your child during the night and note anything unusual such as snoring, movements, or breathing problems. You can share this information with your pediatrician or a sleep specialist.

Note that children need more sleep than adults. Here’s an overview of the recommended amount of sleep by age:

  • Toddlers: 14 hours
  • Preschoolers: 12 hours
  • Elementary and middle schoolers: 10 hours
  • Adolescents: 9 hours
  • Adults: 7 to 8 hours

Helping your child sleep better will also help you as their caregiver. Caregivers and parents of children with ASD tend to have 
more sleep problems than the average adult, whether due to the emotional stress of raising an autistic child or interruptions during the night from their child. Further, parents of autistic children sleep less overall, have worse sleep quality, and wake up earlier than other parents.

Behavior changes

Many behavioral changes can completely resolve or at least alleviate sleep issues for children with autism. The following tips have been helpful for parents:

1. Keep the bedroom cool, dark, and quiet.Children with ASD have heightened sensitivity and can be more sensitive to their environment than other children, so you may want to invest in blackout curtains and remove any stimulating electronics. Limit television time in the hours before bed as it can overstimulate their already sensitive brains. Instead, focus your child’s attention to quiet activities like drawing, puzzles, or reading.

2. Practice good sleep hygiene and establish a bedtime routine.Bedtime routines can help children fall asleep faster, according to research by Vanderbilt University. Repeat the same activities in the same order each night 30 minutes before bedtime, including when your child brushes their teeth and if you read a bedtime story together. Have your child go to sleep and wake up at the same time, regardless of whether it’s a weekday or weekend.

Children with autism can show a strong favoritism towards objects. Lean into this by using the same pajamas and objects in the bedtime routine. Find a way to include multiple objects (such as two stuffed animals) so your child can still sleep if one item becomes unavailable.

Prepare your child for bedtime by reminding them that it’s coming up, so they don’t get irritated by a sudden transition. Use something consistent, whether it’s a verbal reminder, or a clock that signals the time.

Because autistic children are highly sensitive, you might consider using relaxation techniques in the bedroom routine, such as a gentle massage or lavender oils during bath time.

3. Adjust your child’s diet and exercise.Watch your child’s diet and take care to remove any foods that they have sensitivity to as an upset stomach can disturb sleep. Children with autism are more likely to have gastrointestinal problems and food allergies or sensitivities, which if ignored, can cause disrupted sleep.

Limit liquid intake before bed to prevent bedwetting. Avoid caffeine (remember that tea, coffee, chocolate, and soda can all be sources of caffeine).

Provide regular exercise earlier in the day so your child can fall asleep better at night.

4. Coach your child to fall asleep without you in the room.Children with autism can have an even harder time falling asleep without their parents than their typically developing peers. Slowly coach your child to fall asleep without you in the room. In the event they wake up during the night, this will also help them fall back asleep on their own.

First, you can also establish a sense of normalcy around falling asleep alone by showing your child a picture of them asleep in their room while you are doing another activity, or limiting any sleep or nap time to take place solely in their bedroom. Then, go through each of these steps until your child falls asleep, doing one step for a few nights at a time before moving on to the next one:

  • Lie next to your child in bed
  • Lie near the bed
  • Sit on a chair inside the bedroom with the door open
  • Sit outside the bedroom but remain visible to your child
  • Sit outside but out of sight, with the door open
  • Sit outside with the door closed
  • Go to your room and sleep

Sleep products

There are many sleep products designed to help individuals with sensory and developmental disabilities fall asleep better.

Waterproof mattresses and bedding

Autistic children who regularly wet the bed may benefit from waterproof mattresses and bedding. These are made from polyurethane and other materials that are easy to clean and do not develop an odor or stain from repeated incontinence.

Bed rails and floor pads

Bed rails prevent falls from individuals who move a lot during sleep from rhythmic movement disorder, night terrors, or epilepsy. Bed rail pads provide a comfortable surface should your child come into contact with the rails during sleep, and floor pads around the sides of the bed can provide further protection against a fall.

White noise machine

A white noise machine or smartphone app can help calm children to sleep using soothing music, white noises, and nature sounds. It also helps drown out other noise in the house they may be sensitive to.

Anti-snoring devices

Autistic children who snore may find relief from anti-snoring mouthpieces. These are fitted by a dentist to move the lower jaw forward and free up airways during sleep. Less extreme options include anti-snoring nasal plugs or pillows. Alternately, more extreme options for cases of sleep apnea include continuous positive air pressure (CPAP) machines, which fit an oxygen mask over the face during sleep.

Weighted blankets

Weighted blankets soothe the uncomfortable sensations from restless leg syndrome. Choose a blanket that weighs 10 percent of your child’s body weight plus 1 pound. Even an autistic child without RLS may prefer a sleeping bag in their bed, finding comfort in the warm, cocoon-like feeling.

Some individuals may have RLS due to an iron deficiency, in which case taking an iron supplement can relieve symptoms.

Light therapy

If your child suffers from hypersomnia or excessive daytime sleepiness, using light therapy boxes in the morning may help them adjust better to being awake during the day.

Melatonin supplements

Melatonin has been shown to help children with ASD fall asleep 28 minutes faster, and sleep longer for 21 minutes. Ask your doctor about giving your child a melatonin supplement. Low doses of 1 to 3 mgs 30 minutes before bedtime can be effective.

Additional autism and ASD resources

Advocacy organizations

  • Autism Speaks funds research, builds community awareness through events, and provides resources for parents, caregivers, and adults with autism. Their Autism Response Team is available at 888-288-4762, and a local resource directory is available on the website.
  • The National Autism Society is a U.K.-based organization that provides resources for caregivers, parents, and health professionals who support people with Autism and Asperger’s syndrome. It offers an Autism helpline and multiple online forums.
  • The Interactive Autism Network funds and publishes research findings related to understanding and treating autism spectrum disorder.
  • Deal With Autism publishes AutisMag, the leading autism magazine with 22,000 subscribers, and offers online diagnostic tests for varying age groups, a community forum, and other resources on its website.
  • The CDC provides demographic data and statistics on autism from their latest research, and reviews diagnosis and treatment options for families and health professionals..
  • The Autism Research Institute funds research, shares the results on their website, and provides educational and coaching resources for health professionals and caregivers of those with ASD.
  • The Art of Autism is a collaborative non profit who promotes awareness by showcasing the artistic abilities of individuals with ASD. Individuals can submit all kinds of art, including blog posts, poetry, videos, visual art, and movie and book reviews.

Forums

  • The AutismWeb Forum connects over 6,000 members with dedicated sections for recipes for special diets, book reviews, the latest research studies, and non-medical treatments for autism.
  • Wrong Planet connects parents and adults with Autism, Asperger’s Syndrome, and ADHD neurological disorders to lean on each other for support. The autism forum alone has over 1.3 million posts.
  • The Autism subreddit has over 18,000 members.
  • ASPIESCentral is a forum for individuals with autism and Asperger’s syndrome. Individuals can also create their own blog.
  • The #autism hashtag is highly active on Twitter.

Blogs

There are many blogs dedicated to Austin, if these lists by HealthlineThe Art of AutismFeedspot, and Autism Speaks give any indication. Some that earned a spot on multiple lists include:

  • The Autism Dad is told from the point of view of a father with three autistic sons.
  • A diary of a Mom is told from the point of view of a mother with an adolescent daughter with ASD.
  • The Autism Daddy shares his experience raising a nonverbal autistic son.
  • Autistic Hoya is the blog of Lydia X.Z. Brown, an autistic and queer writer, speaker, and activist.
  • Rhema’s Hope documents the journey of Rhema, a previously nonverbal autistic girl who also has a seizure disorder. Rhema’s mom blogs and shares conversations from Rhema herself.
  • The Invisible Strings is written by autistic adult M. Kelter, who shares stories about how the disorder has shaped his life and experiences.
  • Squidalicious is managed by a woman with an autistic teenage son. Her blog promises geekery, parenting, and autism.
  • Four Plus an Angel is a mother of four, the eldest of which is autistic. Her experience is also informed from her previous work at an autism center.

Books

The following books cover sleep issues for children and adults with ASD. All are available in print or Kindle editions on Amazon. For more books on ASD, take a look at the extensive resource list on Autism Speaks as well as the Best Sellers list on Amazon for Autism & Asperger’s Syndrome.

EVERYTHING YOU NEED TO KNOW ABOUT SLEEP DEPRIVATION

Posted on August 15, 2018 at 11:09 AM Comments comments (256)
Most of us live in a culture that glorifies busyness. We stay up late to get things done, then we get up early so we can get to work on time. We try not to think about how little sleep we’re getting, how much coffee we’re drinking, and how tired we feel. After all, thinking about it just makes us feel worse, and we feel like we can’t do anything to change the situation. We are just going to have to learn to function while sleep deprived.

Sleep deprivation, at its most basic, means not getting enough sleep. How much sleep you need will depend on who you are and how much you do in a day, but most people need between 7 and 9 hours every night in order to function well the next day. Miss out on some sleep for just a few days, and you will notice its effects.

Symptoms of Sleep Deprivation

Some symptoms of sleep deprivation are easy to spot. People who are yawning, who are having trouble staying awake in classes or in meetings, or who are always particularly moody or emotionally touchy are, quite possibly, sleep deprived.

However, there are other symptoms that can be associated with sleep deprivation, too. Sleep deprived people can be clumsy, can have trouble making decisions or consistently make poor decisions, and they may always be hungry. They may be accident prone, in their vehicles or otherwise, and they may get sick easily or have trouble getting better when they do fall ill.

All of this happens because the human body needs sleep. We are made to sleep and, when we don’t, it has consequences for how (and how well) the body functions.

Effects of Sleep Deprivation

The above-mentioned symptoms occur because of the effects of sleep deprivation on the human body. Here are just a few health issues that seem to be caused, at least in part, by a lack of sleep.

Immune System Problems

During sleep, the body produces cytokines and other substances that fight infection. When we don’t sleep enough, we don’t have enough time to produce all of these that we need. Then, when something invades the body, we can’t fight it off as effectively.

Cytokines also help fight inflammation in the body, which has been tied to heart disease, autoimmune diseases, and more. When the body isn’t producing enough of these substances, inflammation rises and the chances of developing these related conditions rise, too.

Diabetes

People who only sleep for a few hours every night don’t process glucose as effectively as those who sleep for at least 8 hours. Researchers don’t know exactly why this happens, but the end result is that those who only sleep a few hours are significantly more likely to develop Type 2 Diabetes.

In addition, once they wake up, people who are sleep deprived release more insulin after they eat. This messes with their blood sugar levels, causes them to store more fat and also heightens their risk of developing Type 2 Diabetes.

Psychological Health

When your sleep, your brain rests and recovers, processing information and storing memories. When it doesn’t get a chance to do these things, it is required to function while exhausted. Thus, sleep deprivation causes you to be impatient, to have wild mood swings, and to struggle to be creative or solve problems well.

Sleep deprivation also correlates with higher levels of:

  • Depression
  • Suicidal thoughts
  • Struggles with attention and focus
  • Paranoia
  • Impulsive behavior

Hormonal Health

Some hormones depend on sleep for their production and release. Testosterone is one of these. You need at least 3 consecutive hours of sleep to make enough. Since both men and women need testosterone to achieve hormonal balance, sleep deprivation can throw this off.

Children and adolescents release more human growth hormone when they sleep well. If they aren’t getting enough rest, it’s possible that their bodies won’t grow and develop as is necessary for good human functioning.

Weight Struggles

In addition to releasing more insulin and being at risk for Type 2 Diabetes, both of which correlate positively with a higher than desired body weight, sleep deprivation causes people to eat more than they need. The body is trying to get the energy that it didn’t get while asleep. However, it has to store these extra calories somewhere and this often makes losing weight much more difficult for people who are sleep deprived.

On top of these issues, people who are sleep deprived are more likely to make poor food choices. Their brains are tired, their impulse control is down, and so they are more likely to eat junk food than their well-rested friends.

Causes of Sleep Deprivation

At its most basic, sleep deprivation is caused by not getting enough sleep. Sometimes, we simply choose not to get enough sleep or to do other things rather than sleep. However, there are also conditions that can cause sleep deprivation, or at least make sleep more difficult. These include:


  • Turning off screens at least an hour before bedtime.
  • Making your bedroom as dark as possible.
  • Making sure you have a comfortable, supportive mattress and pillow.
  • Not napping too much during the day.
  • Setting yourself up for good sleep with a relaxing bedtime routine.
  • Going to bed and getting up at the same time every day.

If you struggle with sleep, you may try implementing some of these strategies and see if your rest improves.

Treatment of Sleep Deprivation

Improving your sleep hygiene, as outlined above, can help you sleep better. However, if you have a sleep disorder or one of the conditions mentioned above, you may need to find an effective treatment for that, too, before you can sleep well.

If you simply need to make more time for sleep, treatment involves moving the pieces of your schedule around until there’s adequate time for sleep. You may have to eliminate some things or learn to use your time differently.

There are medications that can help you sleep, but these tend to have significant side effects. If nothing else works, it’s definitely worth talking to your doctor about the pros and cons of these medications for your particular situation. If medicine is the only way to sleep better, you may need to consider taking it for a while.

Sleep deprivation is a major problem, but it is very treatable. We need to become a culture that values rest as much as we value work and efficiency. As more and more of us come to prioritize sleep in our own lives, this will slowly change. Be part of the revolution! Get more sleep today!

BECOMING A HAPPY EMPTY NESTER

Posted on January 25, 2018 at 8:47 AM Comments comments (180)
What is empty nest syndrome?

Empty nest syndrome occurs when parents experience feelings of sadness and loss as their last child leaves home. Though many parents encourage and support their children in becoming independent, watching them leave is nonetheless painful. You might wake up to a shockingly quiet house, no longer filled with children who need your attention. There is plenty to miss — being involved in their daily lives, the constant sound of people around and all the time you spent taking care of their needs. Many parents feel depressed, confused and a deep sense of purposelessness when they no longer have a child’s needs taking up so much of their time.
On top of being plagued by these powerful emotions, you might also be concerned about your child’s safety out there in the world alone. You may even doubt that they’ll be able to take care of themselves without you there to guide them. This transition can be an especially big struggle if your last child leaves the nest sooner than you hoped. If you only have one child or see your main purpose in life as being a parent, you might have a significantly harder time adjusting to an empty nest.
What’s the impact of empty nest syndrome?
In the past, people thought that empty nest syndrome, if not dealt with, would lead to depression, substance abuse, identity crisis and marriage/relationship issues. This can still be true.

Those at the greatest risk of experiencing empty nest symptoms are:
  • People with a history of struggling with separation and change.
  • Full-time parents.
  • People dealing with health issues, retirement and aging parents of their own.
  • Parents who believe their child is not prepared to leave home.

The good news is that while those issues are a concern, they aren’t a concern for everyone. For most, symptoms of empty nest syndrome decrease over time and can be prevented, mitigated or treated.
Recent studies suggest that an empty nest might actually enhance lives by improving relationships and boosting freedom — both yours and your child’s. After an initial period of loss, or manageable fluctuations of sadness, many empty nesters saw a reduction in work stress and family conflicts. When your last child leaves home, yes, it can be sad, but it can also be a new opportunity to reconnect with your partner, your friends and your life. Without the added stress of kids at home, you have more time to devote to your marriage, hobbies and yourself. One of the best ways to cope healthily with an empty nest is to be prepared.

How can I get ready for an empty nest?
  1. Plan Ahead
  2. The benefit here is two-fold — you can plan for your first few weeks without a child at home, and you can  be better prepared for life on his or her own. We’re all in different places when we take that first step out. Some young adults have never done their own laundry, while others have been responsible for paying their bills on time. Assess your child’s self-sufficiency and what skills they need to learn to land on their feet. Then, .Take a vacation, , start a part-time job or a new class. Take stock of the free time you’ll now have, and find a way to fill at least a portion of it up right away.
  3. Get Reacquainted with Your Partner
  4. You’ve spent the last 18 years, at least, as mom and dad, and now you get to . Take a staycation or second honeymoon where you can  to each other in your newly-empty home. Your relationship is yours again. Celebrate together!
  5. Dream Big
  6. Make a list of things you always wanted to do but never had the time or resources for because of your children. Maybe it’s time to consider a whole a new career or look into going back to college and getting a degree. Maybe a road trip to national parks or the country’s biggest cities is on your list.  Get your passport ready and take the plunge. Open the doors and see what adventures await.
  7. Plan and Dream, But Avoid Big Changes
  8. It’s OK to let your imagination run wild, but try not to make any big moves just yet. Vacations aside, take time to adjust instead of immediately throwing your house on the market. It can take  to fully adjust to an empty nest, so indulge with caution. Plus, you’ll want to be available in case that young adult turns out to be a boomerang child, and within a few months flies back into the nest.
  9. Connect with other Empty Nesters
  10. You aren’t the first and only person to go through empty nest syndrome. There are thousands of other  who are going through a similar experience. Reach out to them through social media, community centers, church, work and networking websites. Think about your child’s friends; their parents are likely having empty nest feelings too. Reach out — it can help you and them.What do I do when the nest is finally empty?In an ideal world, you wouldn’t wait until your child leaves home to think about how this will impact you. The sooner you create a plan to get ahead of these emotions, the better off you will be when your child leaves home. Starting to prepare when your children are still young isn’t just about preparing you — it’s also about gradually making sure the  and exciting for everyone.Even still, you can only plan and prepare so much. What happens when you wake up at 2 a.m. in cold sweats because you no longer know your purpose in life? Here are some  to use to prepare and maintain emotional health and stability when dealing with an empty nest:
    • Make a list of the roles you currently fill that require the bulk of your time and energy. Some examples include: partner, parent, friend, family member, pet owner, job title and volunteer roles. Also, if you are really into a sport or activity — you regularly train for and run marathons or play on a recreational softball league — include those, too. Then, go through your list and rank them by importance, first in responsibility and second in time.
    • Determine which roles you want to expand, and come up with ideas for how to do it. For instance, if you have a spouse or partner, you could expand that role by trying to discover new mutual interests that allow you to spend more time together. If you are single, maybe with the final child out of the house, you finally have the time to enter the dating world.
    • Make a list of things you always wanted to try, adventures you always wanted to have, and hobbies you set aside long ago for parenthood. Check out activities at community colleges that help you connect to people with similar interests, or visit websites like Meetup.com to find group activities. If you have trouble getting started, don’t worry. Parenting has been your primary extracurricular activity for decades. It’s only natural to feel a bit rusty. Flip through old photos and connect with old friends to rekindle interests you had before your children entered your life.
    • Start a project. While it’s far too soon to think about turning your child’s old room into a home office, there are plenty of other things that you can do around the house to help you adjust to the new dynamic. Declutter and organize nooks and catch-alls that have piled up over the years. This doubles as an accomplishment and a way to renew the energy you feel in your home. Reorganizing and tossing old clutter may motivate you to make the home upgrades that you’ve always wanted or inspire projects that transition well as you and your family enter new stages of life.

    Most importantly, try to  before your child moves out so that your calendar, and life, is full before they leave. It’s only natural to feel a sense of loss when your last child moves out, so don’t worry if you don’t feel excited or overjoyed at first. You’ll get there in your own time. Try to get involved in new activities and interests that allow you to focus on your emotional adjustment and reduce some of the emptiness you feel, both in your home and your heart.

JANE FONDA WORKOUT

Posted on July 13, 2015 at 1:14 PM Comments comments (62)
Love this classic Jane Fonda Workout!!!  Exercise is one of the best treatments for depression and anxiety.

RISK FACTORS FOR SUICIDE

Posted on August 24, 2014 at 10:35 PM Comments comments (577)
RISK FACTORS FOR SUICIDE

by American Foundation for Suicide Prevention

Risk factors for suicide are characteristics or conditions that increase the chance that a person may try to take her or his life. Suicide risk tends to be highest when someone has several risk factors at the same time.

The most frequently cited risk factors for suicide are:

  • Mental disorders, in particular:
    • Depression or bipolar (manic-depressive) disorder
    • Alcohol or substance abuse or dependence
    • Schizophrenia
    • Borderline or antisocial personality disorder
    • Conduct disorder (in youth)
    • Psychotic disorders; psychotic symptoms in the context of any disorder
    • Anxiety disorders
    • Impulsivity and aggression, especially in the context of the above mental disorders
  • Previous suicide attempt
  • Family history of attempted or completed suicide
  • Serious medical condition and/or pain

It is important to bear in mind that the large majority of people with mental disorders or other suicide risk factors do not engage in suicidal behavior.

Environmental Factors That Increase Suicide Risk

Some people who have one or more of the major risk factors above can become suicidal in the face of factors in their environment, such as:

  • A highly stressful life event such as losing someone close, financial loss, or trouble with the law
  • Prolonged stress due to adversities such as unemployment, serious relationship conflict, harassment or bullying
  • Exposure to another person’s suicide, or to graphic or sensationalized accounts of suicide (contagion)
  • Access to lethal methods of suicide during a time of increased risk


Again, though, it is important to remember that these factors do not usually increase suicide risk for people who are not already vulnerable because of a preexisting mental disorder or other major risk factors. Exposure to extreme or prolonged environmental stress, however, can lead to depression, anxiety, and other disorders that in turn, can increase risk for suicide.
Protective Factors for Suicide

Protective factors for suicide are characteristics or conditions that may help to decrease a person’s suicide risk. While these factors do not eliminate the possibility of suicide, especially in someone with risk factors, they may help to reduce that risk. Protective factors for suicide have not been studied as thoroughly as risk factors, so less is known about them.

Protective factors for suicide include:

  • Receiving effective mental health care
  • Positive connections to family, peers, community, and social institutions such as marriage and religion that foster resilience
  • The skills and ability to solve problems


Protective factors may reduce suicide risk by helping people cope with negative life events, even when those events continue over a period of time. The ability to cope or solve problems reduces the chance that a person will become overwhelmed, depressed, or anxious. Protective factors do not entirely remove risk, however, especially when there is a personal or family history of depression or other mental disorders.
Warning Signs for Suicide

In contrast to longer term risk and protective factors, warning signs are indicators of more acute suicide risk.
Thinking about heart disease helps to make this clear. Risk factors for heart disease include smoking, obesity, and high cholesterol. Having these factors does not mean that someone is having a heart attack right now, but rather that there is an increased chance that they will have heart attack at some time. Warning signs of a heart attack are chest pain, shortness of breath, and nausea. These signs mean that the person may be having a heart attack right now and needs immediate help.

As with heart attacks, people who die by suicide usually show some indication of immediate risk before their deaths. Recognizing the warning signs for suicide can help us to intervene to save a life.

A person who is thinking about suicide may say so directly: “I’m going to kill myself.” More commonly, they may say something more indirect: “I just want the pain to end,” or “I can’t see any way out.”

Most of the time, people who kill themselves show one or more of these warning signs before they take action: 

  • Talking about wanting to kill themselves, or saying they wish they were dead
  • Looking for a way to kill themselves, such as hoarding medicine or buying a gun
  • Talking about a specific suicide plan
  • Feeling hopeless or having no reason to live
  • Feeling trapped, desperate, or needing to escape from an intolerable situation
  • Having the feeling of being a burden to others
  • Feeling humiliated
  • Having intense anxiety and/or panic attacks
  • Losing interest in things, or losing the ability to experience pleasure
  • Insomnia
  • Becoming socially isolated and withdrawn from friends, family, and others
  • Acting irritable or agitated
  • Showing rage, or talking about seeking revenge for being victimized or rejected, whether or not the situations the person describes seem real


Individuals who show such behaviors should be evaluated for possible suicide risk by a medical doctor or mental health professional.

What To Do When You Suspect Someone May Be at Risk for Suicide

Take it Seriously

  • 50% to 75% of all people who attempt suicide tell someone about their intention.
  • If someone you know shows the warning signs above, the time to act is now.


Ask Questions

  • Begin by telling the suicidal person you are concerned about them.
  • Tell them specifically what they have said or done that makes you feel concerned about suicide.
  • Don't be afraid to ask whether the person is considering suicide, and whether they have a particular plan or method in mind. These questions will not push them toward suicide if they were not considering it.
  • Ask if they are seeing a clinician or are taking medication so the treating person can be contacted.
  • Do not try to argue someone out of suicide. Instead, let them know that you care, that they are not alone and that they can get help. Avoid pleading and preaching to them with statements such as, “You have so much to live for,” or “Your suicide will hurt your family.”


Encourage Professional Help

  • Actively encourage the person to see a physician or mental health professional immediately.
  • People considering suicide often believe they cannot be helped. If you can, assist them to identify a professional and schedule an appointment. If they will let you, go to the appointment with them.


Take Action

  • If the person is threatening, talking about, or making specific plans for suicide, this is a crisis requiring immediate attention. Do not leave the person alone.
  • Remove any firearms, drugs, or sharp objects that could be used for suicide from the area.
  • Take the person to a walk-in clinic at a psychiatric hospital or a hospital emergency room.
  • If these options are not available, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for assistance.


Follow-Up on Treatment

  • Still skeptical that they can be helped, the suicidal person may need your support to continue with treatment after the first session.
  • If medication is prescribed, support the person to take it exactly as prescribed. Be aware of possible side effects, and notify the person who prescribed the medicine if the suicidal person seems to be getting worse, or resists taking the medicine. The doctor can often adjust the medications or dosage to work better for them.
  • Help the person understand that it may take time and persistence to find the right medication and the right therapist. Offer your encouragement and support throughout the process, until the suicidal crisis has passed.

RAISING AWARENESS FOR BINGE EATING DISORDER

Posted on February 28, 2013 at 10:08 PM Comments comments (60)
AMERICAN PSYCHIATRIC ASSOCIATION
Tuesday, February 26, 2013

What is Binge Eating Disorder?

Binge Eating Disorder involves frequent overeating during a discreet period of time (at least once a week for three months), combined with lack of control and is associated with three or more of the following:
  • Eating more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of feeling embarrassed by how much one is eating
  • Feeling disgusted with oneself, depressed, or very guilty afterward 
Binge Eating Disorder also causes marked distress and does not occur during the course of another eating disorder, such as Anorexia Nervosa or Bulimia.

What is the Diagnostic and Statistical Manual of Mental Disorders?
The Diagnostic and Statistical Manual of Mental Disorders is used by mental health professionals around the world to help them accurately diagnose psychiatric disorders. The fifth edition of this manual (DSM-5) will be released in May 2013 after 14 years of extensive research studies and input from the best experts in the field.

What is different about Binge Eating Disorder in DSM-5?
Binge Eating Disorder was previously categorized as a “diagnosis for further study.” In DSM-5, it is defined as a unique psychiatric condition with more specific criteria.

Why is it important that Binge Eating Disorder is being recognized as a unique psychiatric condition in DSM-5?
Being recognized as a true mental disorder will raise public awareness of this troubling condition and may help individuals identify themselves as needing support. Increased awareness can lead to increased interest and funding in the research community, so that we may continue to learn more about this disorder and find better treatments. This designation as a “disorder” may also make insurance companies more likely to cover therapy and medications used to treat Binge Eating Disorder. 

What should I do if I think I am suffering from Binge Eating Disorder?
Binge Eating Disorder treatment is complex and individualized. It can include therapy, medications, and addressing other psychiatric conditions or health problems such as obesity that are also occurring. If you think that you, or a loved one, are suffering from this condition, you should contact a mental health professional for diagnosis and treatment recommendations.

How is Binge Eating Disorder treated?
If you decide to see a psychiatrist for treatment of Binge Eating Disorder, he or she will start by asking questions about your medical and psychiatric history and symptoms that you are concerned about. Common components of a treatment plan might include addressing any underlying medical problems such as obesity or high blood pressure and psychotherapy to help with depressionanxiety, or other emotional problems. Medications may also be used if your doctor thinks it is indicated. There is no magic cure for Binge Eating Disorder, and your psychiatrist will work with you to create an individualized treatment plan.

MOST GUN DEATHS ARE SUICIDES

Posted on February 28, 2013 at 10:02 PM Comments comments (133)
AMERICAN PSYCHIATRIC ASSOCIATION
THURSDAY, FEBRUARY 14, 2013  

Since the schoolhouse massacre in Newtown, Conn., much of the nation’s attention has focused on mass shootings. But deaths involving guns are very likely to involve one victim—the shooter. 

A report in the New York Times today, drawing on statistics from the federal Centers for Disease Control and Prevention, notes that nearly 20,000 of the 30,000 deaths from guns in the United States in 2010 were suicides. 

Experts quoted by the Times emphasize that guns are particularly lethal. And it cites statistics from the Harvard Injury Control Research Center showing that suicidal acts with guns are fatal in 85 percent of cases, while those with pills are fatal in just 2 percent of cases. 

“Suicidal acts are often prompted by a temporary surge of rage or despair, and most people who attempt them do not die,” according to the report. “In a 2001 study of 13- to 34-year-olds in Houston who had attempted suicide but were saved by medical intervention, researchers from the CDC found that, for more than two-thirds of them, the time that elapsed between deciding to act and taking action was an hour or less. The key to reducing fatalities, experts say, is to block access to lethal means when the suicidal feeling spikes.”

The Times article is here. For more on the subject of suicide see Psychiatric News here


(Image: Vartanov Anatoly/shutterstock.com)
Posted by Psychiatric News Alert at  Email ThisBlogThis!Share to TwitterShare to FacebookLabels: gunssuicides

FDA approves injectable drug to treat opioid-dependent patients

Posted on February 2, 2013 at 8:27 PM Comments comments (79)
FDA NEWS RELEASEFor Immediate Release: Oct. 12, 2010
Media Inquiries: Shelly Burgess,  301-796-4651, [email protected]
Consumer Inquiries: 
 888-INFO-FDA

The U.S. Food and Drug Administration today approved Vivitrol to treat and prevent relapse after patients with opioid dependence have undergone detoxification treatment.Vivitrol is an extended-release formulation of naltrexone administered by intramuscular injection once a month. Naltrexone works to block opioid receptors in the brain. It blocks the effects of drugs like morphine, heroin, and other opioids. It was approved to treat alcohol dependence in 2006.“Addiction is a serious problem in this country, and can have devastating effects on individuals who are drug-dependent, and on their family members and society,” said Janet Woodcock, M.D., director of FDA’s Center for Drug Evaluation and Research. “This drug approval represents a significant advancement in addiction treatment."The safety and efficacy of Vivitrol were studied for six months, comparing Vivitrol treatment to placebo treatment in patients who had completed detoxification and who were no longer physically dependent on opioids. Patients treated with Vivitrol were more likely to stay in treatment and to refrain from using illicit drugs. Thirty-six percent of the Vivitrol-treated patients were able to stay in treatment for the full six months without using drugs, compared with 23 percent in the placebo group.Patients must not have any opioids in their system when they start taking Vivitrol; otherwise, they may experience withdrawal symptoms from the opioids. Also, patients may be more sensitive to opioids while taking Vivitrol at the time their next scheduled dose is due. If they miss a dose or after treatment with Vivitrol has ended, patients can accidentally overdose if they restart opioid use. Side effects experienced by those using Vivitrol included nausea, tiredness, headache, dizziness, vomiting, decreased appetite, painful joints, and muscle cramps. Other serious side effects included reactions at the site of the injection, which can be severe and may require surgical intervention, liver damage, allergic reactions such as hives, rashes, swelling of the face, pneumonia, depressed mood, suicide, suicidal thoughts, and suicidal behavior.Vivitrol should be administered only by a health care provider as an intramuscular injection, using special administration needles that are provided with the product. Vivitrol should not be injected using any other needle. The recommended dosing regimen is once a month.Consumers and health care professionals are encouraged to report adverse events to the FDA's MedWatch program at  800-FDA-1088 or online atwww.fda.gov/medwatch/how.htm.Vivitrol is manufactured by Alkermes, Inc.

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