Clinical Evaluation: Part Two
The way that patients present for evaluation, testing and follow up is not always straightforward, and this is particularly true in the presence of mental health disorders. An understanding of mental health disorders, which often overlap with sleep disorders, is important. Being equipped to discern the differences and similarities in sleep and mental health disorders when reviewing a patient’s symptoms and history can assist the sleep technologist and the clinical sleep health educator (CCSH) to differentiate these disorders. Module six of the AAST Enhanced CCSH Designated Education Program outlines the important role that clinical evaluation plays in managing these patients.
This module reviews multiple mental health disorders, including depression, anxiety, suicide and suicidal ideation, and post-traumatic stress disorder, also known as PTSD. The symptoms and behaviors that occur in those who have both mental health disorders and sleep disorders can be seen in children and adults. Case reviews are presented that discuss common symptoms in patients with mental health disorders, such as major depression and bipolar disorder, that may also have sleep disorders such as obstructive sleep apnea (OSA) and advanced sleep phase syndrome (ASPS). These cases illustrate that there is often an overlap in both symptoms and presentation, and provide helpful information on the most common mental health disorders to assist the CCSH in differentiating them.
The module also looks at several studies linking OSA with depression; there are overlapping symptoms found in these patients and patients with either disorder should be evaluated for the other. There is no psychiatric diagnosis that does not involve sleep in some way. Depression can cause or worsen insomnia and insomnia increases the risk of depression. Many mental health disorders affect sleep structure, causing or exacerbating sleep disorders.
Additionally, while we do not tend to think about suicide in our patients, there is a significant risk and a good reason for the CCSH to become familiar with this mental health disorder. It has been shown in several studies that sleep problems, particularly insomnia, can be a risk for suicide, especially in adolescents and young adults. Eye-opening information is provided in this module, such as the correlation of bipolar disorder and suicide, and the role of the health care educator working with these patients is discussed.
REM behavior disorder (RBD), PTSD, attention deficit hyperactivity disorder (ADHD) and dementia, including Alzheimer’s dementia, are all also reviewed, providing excellent basic information relevant for the CCSH working with sleep disorders patients. The module also reviews the effects medications have on treating mental health in patients with comorbid sleep disorders, and takes a deep dive into how sleep is impacted by substances such as alcohol, nicotine, caffeine, antidepressants, stimulants, cocaine and cannabis. Understanding the effects of these substances and medications, their role in patient care and their effects on sleep are all of importance as they impact the education provided by the CCSH.
As educators, it’s important that you have an understanding of common mental health disorders and how to properly evaluate and educate those suffering from them. With this module, you will not only be furthering your skills in patient evaluation, you will also be able to think beyond the scope of sleep disorders. Expand your horizons!