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Sleep apnea: how is it recognised & what can be done about it?

I have already written a couple of posts on sleep apnea -"Sleep apnea - what is it, how common is it and how does it affect mortality & physical health?" and "Sleep apnea - how does it affect psychological health?".  In this third & last post of the sequence, I'll explore how we can recognise sleep apnea and what we can do about it.

Sleep apnea - how does it affect psychological health?

I have already written a first post "Sleep apnea - what is it, how common is it and how does it affect mortality & physical health?" which highlights that sleep apnea is a common, regularly unrecognised disorder, occurring in approaching 1 in 5 adults and that, particularly as it becomes more severe - probably approximately 1 in 10 sufferers (Li et al, 2015) - sleep apnea is linked with a wide range of serious diseases and with significantly increased death rates.  In this second post, I'll look at the relevance of sleep apnea for psychiatric disorders.

Introduction & monitoring

“ Education should be "not the filling of a pail but the lighting of a fire." ” - William Butler Yeats

Here are a series of forms that I use almost every session with clients, or for screening and orientation at the start of therapy:

Alcohol: know your limits and increase the price

A recent article in the British Medical Journal (Kmietowicz 2009) reports that "The chief medical officer for England has called for a minimum price of 50 pence (0.54; $0.70) to be charged for a unit of alcohol to reduce excessive drinking and its associated harms.  Liam Donaldson said that antisocial drinking should be targeted in the same way as smoking in public places so that being drunk is no longer an aim or socially acceptable.  ‘England has a drink problem and the whole of society bears the burden,' said Professor Donaldson at the launch of his 2008 annual report. ‘The passive effects of heavy drinking on innocent parties are easily underestimated and frequently ignored. The concept of passive drinking and the devastating collateral effect that alcohol can have on others must be addressed on a national scale.'  He said that evidence shows that price and access are the two key factors that can help to change drinking habits, as they were for tobacco."  

The CAGE questionnaire as a screen for alcohol problems

An article in one of this month's editions of the Journal of the American Medical Association celebrates the publication of the CAGE alcohol screening questionnaire by Charles Ewing 25 years ago.  CAGE is a mnemonic to help remember the four simple questions.  "Have you ever ...

1.) felt the need to cut down your drinking?
2.) felt annoyed by criticism of your drinking?
3.) had guilty feelings about drinking?
4.) taken a morning eye opener?

An affirmative answer to 2 or 3 of these questions makes an alcohol problem likely, while a score of 4 suggests a diagnosis of alcoholism is almost certain. 

The questions can be used in most clinical settings to identify people who need to be checked out more fully.  In the United States, 30% of primary care physicians report  regularly screening for substance abuse.  Of these physicians 55% use the CAGE.  See too the January blog posting on The demon drink. 

Depression assessment

“ Disagreements between scientists of good intention are merely truth in the making. ” - Andrews

Depression assessment scales come in two basic forms - interviewer/clinician rated and sufferer/patient rated.  As stated in the background information on the IDS/QIDS questionnaires (see below) "There are several accepted clinician rated and patient self report measures of depressive symptoms. The most commonly used clinician rated scales are the 17, 21, 24, 28, and 31 item versions of the Hamilton Rating Scale for Depression (HRSD) (Hamilton 1960, 1967), and the 10-item Montgomery-Asberg Scale (Montgomery and Asberg 1979). The most frequently used self-reports include the 13, and 21 item version of the Beck Depression Inventory (BDI) (Beck et al. 1961), the BDI-II (Beck et al. 1996), the Zung Depression Rating Scale (Zung 1965), the Carroll Rating Scale (CRS) (Carroll et al. 1981), and the Patient Health Questionnaire - 9 (PHQ-9) (Kroenke et al.

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