Change Your Brain Every Day - Are Sleep Disorders Associated with Mental Disorders? Pt. 2 with Dr. Shane Creado

Episode Date: July 31, 2018

Science has told us that sleep related disorders such as sleep apnea are associated with depression, ADHD, PTSD, obesity, and other conditions. But what if these sleep disorders are not merely a symptom of these other conditions, but rather a cause of them? In part 2 of a series on sleep with Dr. Shane Creado, Dr. Daniel Amen and Tana Amen discuss the importance of doing a sleep study to see if a common sleep related disorder such as sleep apnea may be causing your conditions.

Welcome to the Brain Warriors Way podcast. I'm Dr. Daniel Amen. And I'm Tana Amen. Here we teach you how to win the fight for your brain to defeat anxiety, depression, memory loss, ADHD, and addictions. The Brain Warriors Way podcast is brought to you by Amen Clinics, where we've transformed lives for three decades using brain spec imaging to better target treatment and natural ways to heal the brain. For more information, visit amenclinics.com.

The Brain Warriors Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceutical products to support the health of your brain and body. For more information, visit brainmdhealth.com. Welcome to the Brain Warriors Way podcast. Welcome back. We are here with Dr. Shane Criotto, an Amen Clinic psychiatrist. I'm so proud of him, sleep medicine specialist, and we're going to tackle sleep apnea. Now why does a psychiatrist care and why do I care about sleep apnea? Because we do brain spec imaging and what I started seeing with spec scans is that people,

they look like they had early Alzheimer's disease on their scan. Interesting. And what it really was was untreated, undiagnosed or diagnosed and untreated, very common sleep apnea and it gives you an oxygen state that really murders brain cells. I have a question. So when people are sleep deprived, Dr. Curado, do you see that that can actually exacerbate or magnify underlying psychiatric issues dramatically? It goes to PTSD, to anxiety disorders, to depression, to schizophrenia and cognitive impairments. And when we think about sleep deprivation and associated factors like sleep apnea, I chose to do sleep medicine training because really I felt our psychiatric training didn't

truly equip us to understand comorbid insomnia and sleep issues. And the reason I say comorbid is because in modern sleep medicine, we don't associate it as primary or secondary insomnia, for example. If the sleep issue is corrected, it improves the mood disorder and vice versa. They need to be tackled individually. So in people with PTSD, anxiety disorders, there's an increased risk of central sleep apnea where their brain triggers the muscles to stop breathing because they're hyperventilating all the time. So that's actually very important because we don't have much time and I want to

talk about sleep apnea and restless leg. But children who have ADHD who snore that they actually may have sleep apnea, that is the primary cause of their ADHD symptoms. And missing that, these are kids that do not respond well to stimulants. And you're really doing them a huge disservice. And correct me if I'm wrong, the idea I've had in my head, when I was young, there was a lot of tonsils and adenoids that were taken out. And they basically stopped that process. And when you have large tonsils or large adenoids, what happens is you can't breathe properly you end up with sleep apnea and now you have learning problems and you're on medicine for ADHD. So you're so right you're so right about that I saw that in in our practice with child and adolescent psychiatry a lot of kids are put on

stimulant medications because they have concentration problems they're falling asleep they're bouncing around their they have behavioral issues. Sleep apnea manifests very different in kids. They'll be irritable, they'll be cranky, they'll be causing trouble, they won't be able to do their homework. They're assumed to be problematic children. They put on medication for behavior issues. It's horrible.

So we need to figure out if there's having sleep apnea and how to correct it. And you're right. Simple strategies. We do a sleep study in a lab, figure out if they stop breathing, treat the obstruction. If the kids have big tonsils or adenoids, those need to be out. And then you need to do a follow-up sleep study in a few weeks to figure out if the issue is resolved or not. Yeah, that's so interesting. So we, like, just it's common sense that we think of if you have a psychiatric issue that it would affect your sleep, but we don't necessarily automatically think that sleep causes these other problems.

Isn't that interesting? So, yeah. So what are the major symptoms of sleep apnea? When should someone suspect it? Okay. Well, sleep apnea simply means a pause of breathing while you're asleep. The most common type is obstructive sleep apnea, where airway closes off And periodically during the course of the night, you stop breathing. So obviously symptoms might be snoring, which is primarily while you're breathing in. It's caused by vibration of the palate, the soft palate and the uvula. You may have morning headaches because your brain has been deprived of oxygen or dry mouth. You may have high blood

pressure. You may feel sleepy during the day because you're sleep deprived. Drowsy driving is deadly. 6,400 fatal accidents in the U.S. alone because of drowsy driving. Of course, if you have a thick neck, generally more than 16 inches. If you're a male, you have double the risk of developing obstructive sleep apnea, unless you're a female who's in menopause, and then there's an equal incidence over there. So these are the important things we need to look for. And if someone meets those criteria, it's worth getting a sleep study done to make sure they don't have sleep apnea. There's a 20% concordance between sleep apnea and depression, which is huge. So we always ask people about thyroid problems and depression.

How often do we ask a few questions like pauses and breathing? Of course, your partner will have to tell you that. Honey, I saw you, you stopped breathing for a few minutes last night. I was terrified. Some partners may be fine with that in that case. I actually helped you. So there are some telltale signs there and they need to be investigated further because sleep apnea can be deadly. So the way we think about sleep apnea is how bad is it? We talk about the number of times someone stopped breathing at night. And if you stop breathing 5 to 15 times per hour, it's considered mild. 15 to 30 times per hour, it's considered moderate. And if you stop breathing more than 30 times per hour during the course of the night, it's considered severe sleep apnea.

But that's very, very simplistic because what if you're stopping breathing 10 times per hour, so-called mild sleep apnea. But that's very, very simplistic because what if you're stopping breathing 10 times per hour, so-called mild sleep apnea, but those poisons are several minutes each or you're having severe dips in your oxygen. That's dangerous. Yeah, that sounds crazy. Now, I have had so many patients diagnosed with sleep apnea. They tried the CPAP for three nights. They hate it. And they just ignore it. I did a YPO retreat where eight YPO members, that's Young Presidents Organization members from Philadelphia, came to our California clinic. I scanned them all. And then as a group, I talked about each of their brains. And I remember this one guy, he was diagnosed three years ago. His brain looked awful. And he's like, well, I was going to get around to it, but I don't like it.

And I just really got after him about you're murdering brain cells every night that you're not taking care of this problem. So if someone is having trouble getting used to the treatment, what do you do? Okay. There are many treatments. People always think, oh, no, I don't want to be tested because you're going to force me to wear a CPAP. But there's many more options. The first thing is weight loss. In fact, if someone loses more than 10% of their body weight,

we should retest them to look and see whether their sleep apnea still needs to be treated with CPAP. You stopped snoring after you lost weight. Now you rarely snore. Thank you. Now the whole world knows this. Yeah, no, thank you. You're the one who tells everybody you lost snore. Thank you. Now the whole world knows this. Yeah, no, thank you. You're the one who tells everybody you lost 20 pounds,

and it affected your snoring. Absolutely. And see, if you lose weight, you're not going to be having disrupted sleep. Your leptin is not going to be driven down. You're not going to be feeling hungry all the time. It's a positive feedback cycle over there. So weight loss is key. Then when we've done the sleep study, some people just have really bad sleep apnea on their back

while they're in their supplied position. Or when they've had alcohol at night, then they snore more. Or when they've had a muscle relaxing medication or Valium, benzodiazepines, then it's best to change the medication or even simply sleep on your side. That's an effective strategy for many people. Oh, how interesting. That is so interesting. All right. We're going to have to stop because I have just, you know, as I'm sitting here talking to you, I want to talk quickly about restless leg syndrome. But then I really want you to talk to our group about dreams and why we dream, what it means. I just think, you know, as two psychiatrists talk, you know, Freud said it was the royal road to the unconscious. Is that complete nonsense? What are your thoughts? Stay with us. Use the code podcast10 to get a 10% discount on a full evaluation at amenclinics.com or on our supplements at brainmdhealth.com.

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