I have seen several people who have come to me being treated for adult Attention Deficit Hyperactivity Disorder who were being treated for obstructive sleep apnea at the same time. Almost always the symptoms of ADHD predate the discovery of the obstructive sleep apnea. Generally neither the sleep specialist nor the ADHD provider knows about the others existence. It is important because if they did, they might change how they treated the patient.
This week an interesting article in the Psychiatric Times pointed out something that I have been teaching about for years.[i] An important part of counseling is a trip to a trusted doctor and a thorough medical work up. There are any number of medical diseases that can and do affect emotions and behavior. It is important to find them and treat them in the best way possible. It is also very important that at least one physician knows all the diagnosis and treatments that the patient is receiving.
The article examined the role that abnormal breathing during sleep plays in changing how we feel and act. “Sleep disordered breathing signs and symptoms overlap with mood, anxiety and other psychiatric disorders. In some cases they may masquerade as these disorders…” Problems such as depression, anxiety, Attention Deficit, a decline in the ability to think, irritability, and difficulty dealing with problems in life all may find their cause in a patient’s inability to breathe normally while sleeping.
The most common cause of sleep disordered breathing in North America is Obstructive Sleep Apnea (OSA). When asleep the patient’s airway is either completely or partially blocked. This requires the individual to reposition themselves in order to breathe and keeps them from achieving normal restorative sleep. Generally, those with OSA are known for their snoring. It can occur in children with large obstructive tonsils and in adults who are overweight. It occurs in thin adults but is much less common. A good question is “has your spouse ever heard you stop breathing while you are sleeping.”
Diseases that can be diagnosed in people who have Sleep Disorder Breathing include anxiety, depression, mood disorders, and Attention Deficit hyperactivity disorder. I have seen many individuals through the years who have been diagnosed with ADHD initially only to be found to have obstructive sleep apnea. Correction of the sleep disorder will most often correct the psychiatric diagnosis too.
There are many important questions to ask in a first counseling session. One them ought to be “how are you sleeping?” For counselees who are not sleeping normally a visit to a trusted doctor is very important
[i] Clinical features of Sleep-Disordered Breathing, Feb 4 2014.