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PaperclipPerfector  2d ago (text post)   727 thread views

Wellness Wednesday for April 2, 2025

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

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Remember OSA cause psychiatric disturbance. The DSM emphasizes that psychiatric problems are not otherwise caused by a substance or medical problem. Consider this with respect to correlation and causation. A strict doctor will not diagnose someone with depression with untreated OSA for the same reason you won't diagnosis someone with mania if they are high on meth.

While this is good care, I rarely see this implemented in practice. GPs bear the brunt of insomnia, though of course it's a perennial concern in psych. I've never seen my bosses actually order formal assessments for sleep apnea, not that we have the equipment to do PSG in a psychiatric hospital.

There are more CPAP and other OSA treatment options than you can imagine. Obviously the UK probably has some limitations on this front but you'd surprised where you can go with this. Don't give up (for yourself OR the patients)!

I sleep just fine these days, thankfully. When it comes to patients, I'll keep an eye on whether GPs have attempted to exclude behavioral or medical causes like OSA, but if they do, it never seems to come up in the notes or referral letters. No mention of CBT-I that I can recall, even if NICE recommends it as the first line intervention, and there's even a dedicated app.

You are correct! I always overstate Benzo risk with patient facing communication and writing because what we are certain on is quite bad enough and it's probably better to emphasize what we may later find to be true. AND...in the best case the Benzo is impairing establishment of more definitive care anyway. I find most patients and clinical staff underestimate just how addictive Benzos are.

Even if the dementia risk wasn't an issue, just the addiction potential and cognitive effects should put most reasonable people off them. The former is nasty, but I guess they beat barbiturates.

Thanks for the pointers!

While this is good care, I rarely see this implemented in practice. GPs handle the brunt of insomnia, though of course it's a perennial concern in psych. I've never seen my bosses actually order formal assessments for sleep apnea, not that we have the equipment to do PSG in a psychiatric hospital.

In a medical setting you should always be thinking this way - just because a patient has a psychiatric complaint doesn't mean your brain should turn off. You'll miss autoimmune encephalitis this way. Also I'm looking at you 95% of emergency medicine physicians.

In psych you should be considering sleep study in a residential or outpatient setting but for crisis or inpatient I get it, other things need to be dealt with first.

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