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Cancer and Mental Health

October is Breast Cancer Awareness Month, which is arguably one of the most discussed cancers in the media. There is a large push to get those assigned female at birth to check themselves regularly for lumps or anything that may feel out of the ordinary. Regular breast screenings are incredibly important to your overall health as early detection of cancer is critical for the best outcomes with treatment. However, one thing that is often not discussed is how cancer and mental health can intersect. 

Cancer and Mental Health

Receiving a cancer diagnosis of any kind can be absolutely life changing and devastating. This is not only true for the patient themselves but also for their loved ones. Many of the treatments can be difficult on the body and certain cancers carry with them lower chances of survival, especially if caught late. 

Some of the most common concerns with cancer and mental health are anxiety and depression, with social isolation as a result of cancer being a risk factor for worsening mental health. 

Many cancer patients experience fear, uncertainty, anger, and disbelief after a cancer diagnosis. There can be a sense of “why me” or “did I do something to deserve this?” This can be especially true for cancers such as lung cancer, which are often related to smoking. However, it is important to understand that no one deserves to get cancer and that doctors are still unsure as to why some people develop it while others don’t. 

Because of the serious nature of a cancer diagnosis, it can be difficult to talk to others about it. This can help contribute to isolation and loneliness. Sometimes cancer patients avoid talking about it out of fear of making others uncomfortable and sometimes it’s because they themselves don’t want to talk about it. It can be helpful to broach the topic with those closest to you just to get their support, if you’re comfortable with it. 

All the feelings someone could have around a cancer diagnosis are perfectly normal. There is nothing inherently wrong with feeling anxious, sad, angry, or any other negative emotion as a result of a diagnosis of this kind. However, when those feelings start to make life more difficult or are getting in the way of quality of life, it’s time to reach out for more support. 

When to Reach Out

Some mental health disorders can be difficult to distinguish from symptoms of cancer or side effects from treatment. For example, depression. Sadness from a cancer diagnosis is perfectly normal and those feelings will wax and wane over time. Depression, however, is much more serious and could require treatment for the best outcomes. 

  • Signs to look out for:
    • Fatigue
    • Changes in appetite
    • Weight loss or gain
    • Changes in sleep patterns
    • Irritability
    • Feeling hopeless
    • Feeling worthless
    • Extreme levels of guilt (out of proportion)

If you feel you may want to harm yourself or are thinking of killing yourself, reach out to your care team ASAP to get help with these feelings. There are many options available for help. 

The standard treatments for depression are something we’ve covered in our blog post about major depressive disorder. However, it is important to know that when it comes to cancer and mental health, one needs to consider the specific ways in which depression can impact treatment and quality of life and how cancer can contribute to MDD. 

Taking care of mental health is associated with better mental health outcomes, possibly because of the likelihood of adhering to treatment and being open to learning more about the diagnosis and what can be done. Being more proactively involved in your treatment plan can make a difference for long-term outcomes. 

How Does Cancer Contribute to Depression?

There are many things about a cancer diagnosis that can impact the likelihood of developing depression. One of the major things is the sense of loneliness and feeling like there’s no one you can open to. It’s incredibly isolating to feel as if you have to hide large parts of yourself from loved ones. 

Other factors include:

  • Body image (self conscious because of bodily changes)
  • Guilt (“Did I do something for this to happen?”)
  • Change in daily activities and plans
  • Change in energy levels
  • Pain
  • The fear of dying
  • Anxiety and panic due to uncertainty and fear
  • Fear of cancer coming back after treatment
  • Fear of what will happen to family
  • Anxiety over medical costs
  • Not being able to work
  • The need for others to help care for them (loss of independence)
  • Long hospital stays

It is worth mentioning that these things can also contribute to worsening mental health of the loved ones of a cancer patient. If someone in your life has been diagnosed with cancer and you feel as if you may be becoming depressed, reach out to someone for more support. 

What Can Help Support Mental Health?

There are many different things someone can do to help support or improve their mental health after a cancer diagnosis. With cancer and mental health support, it’s important that your cancer care team is part of some of these choices. Depending on your health and needs, some options may not be suitable, so get guidance from your care team before making any major changes. 

Somethings you can do:

  • Support groups
  • Therapy
  • Medication
  • Mindfulness practices like
    • Meditation
    • Journaling
    • Yoga
    • Breathing exercises
  • Eating balanced, nutritious meals
  • Light exercise, if possible (check with your care team)
  • Seeking out social support from loved ones
  • Pastoral counseling, for those who are spiritual, can be very helpful
  • Spending time with pets/animals
  • Keeping to your normal routine within reasonable limitations

It can also be helpful to ask the care team where you go for appointments or treatment about what options they have at the facility to help support cancer and mental health together. It could be that there are options you’re not even aware of that are there!

Things to ask about:

  • Therapy dogs at the facility you attend for treatment
  • Counselors at the facility you attend
  • Social workers who can connect you to counselors, especially those who specialize in the mental health needs of cancer patients

Cancer can be a life changing diagnosis, especially if caught in the later stages. However, people are living longer and with higher quality of life even with advanced cancer than they ever have before. While all feelings around cancer are valid, you don’t have to suffer with poor mental health, too. Make sure to seek out help, whether you’re the patient or a loved one. When it comes to cancer and mental health, you have options to take care of yourself and support the best quality of life for yourself. 

Resources:

https://www.cancer.gov/about-cancer/coping/feelings

https://www.cancer.org/cancer/survivorship/coping/support-service-animals.html

https://www.cancer.org/cancer/managing-cancer/side-effects/emotional-mood-changes.html

https://www.macmillan.org.uk/cancer-information-and-support/treatment/coping-with-treatment/cancer-and-your-emotions

https://www.mhanational.org/cancer-and-mental-health

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LGBTQIA+ History Month

October is LGBTQIA+ History Month! One of the big questions people have in response to this is how is it different from Pride Month in June? There are some key differences we’ll discuss in this blog post, along with how LGBTQIA+ History Month started and what its purpose is. The hope is that with more understanding of things involving the LGBTQIA+ community, we can foster more understanding for their mental health needs, as well!

So, What IS LGBTQIA+ History Month?

Simply, it’s exactly what it sounds like. It’s a month dedicated to the history of the LGBTQIA+ community, focusing on key figures that have contributed to the forwarding of their civil rights. It also is meant to educate people about the community at large. 

Every October, the GLAAD and LGBTQ History Month websites have a write up on important historical (and current) members of the community. The LGBTQ History Month website dedicates one day of the month to a figure and it’s possible to go back into the archives to see the past years’ icons. 

It was started by a high school teacher, Rodney Wilson, in 1994 in Missouri. He was the first publicly out educator in that state and he felt it was important to have a month that would help educate people more about the gay community and the need right gay rights, in a way that was approachable and focused on the icons and important people that had made strides to make things better. 

He chose October because October 11th (today!) is National Coming Out Day in the USA. October also marks the anniversaries of some of the first marches in LGBTQIA+ history in the 70’s and 80’s. 

Okay, but isn’t that just Pride Month?

Well, no, not exactly. Pride Month is focused heavily on the history of political activism in the community, along with an emphasis on proudly being out and living an authentic life, without hiding. It can seem very similar on the outside, but the key differences are really on the focus of the months. LGBTQIA+ History Month is more aligned with general education about the community, with a focus on key iconic figures throughout time that have contributed to the movement of education and civil rights. 

Pride Month is more well known because of its heavy emphasis on, well, pride and being proud of oneself despite the cisheteronormative expectations of society telling the community that they are too different. It’s a celebration as much as it is a call to action. LGBTQIA+ History Month is educational. 

So, Why Does It Matter?

It matters because history is important. Many of these icons are not well known, especially to the younger generations of LGBTQIA+ individuals. What these figures did in their lives and how they contributed to the community is something that can help continue to foster not only understanding but to empower LGBTQIA+ youth to live their lives in ways that can change the world, as well. 

Representation is important for everyone and in a world where we still see widespread prejudice and misunderstanding about this community, the more education we can have around these topics, the better!

It’s all just an effort to continue to make the world a kinder, more understanding place for people from all kinds of different backgrounds. 

LGBTQIA+ Mental Health

We’ve discussed in a previous post about how being part of this community can contribute to poorer mental health outcomes. This is primarily because of the prejudices that exist and the fears many individuals have around their safety and if people will accept them. These things can take a very real toll on the mental health of anyone, especially someone who will have to encounter these considerations often when having to decide how much of their lives and selves to share with others. 

There is nothing inherently about being LGBTQIA+ that contributes to poorer mental health and it is almost entirely connected to how society responds to individuals who are different from them. The more education we can put out, the more we can hope for a day when those statistics will change. 

Resources:

LGBTQ History Month Spotlights: Celebrating Unsung Icons

https://lgbthistorymonth.com

https://en.wikipedia.org/wiki/LGBT_History_Month#United_States

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Staying Ahead of SAD and the Winter Blues

In a previous blog post we’ve talked about major depression with a seasonal pattern, better known as SAD. That post was specifically meant to bring awareness to the summer pattern, as it’s less well known. However, this post is for the more common pattern of SAD, which is typically experienced in the fall and winter. This post will also touch on the winter blues, which while similar, is not the same as seasonal depression!

Depression or the Winter Blues?

A lot of people use these terms interchangeably, but technically there is a difference. For most people, the coming of winter signals the end of a lot of things. We don’t spend as much time out of the house doing things, we find ourselves sleeping more, and often we find ourselves eating more. It doesn’t help that winter is packed with a lot of stressful holidays that can be very difficult for some people. All of this can contribute to just generally feeling a bit more down during the winter than usual. Generally, this doesn’t really get in the way of functioning or enjoyment of life.

Seasonal depression, however, is different. A depression diagnosis implies, to some extent, an impact on functioning and enjoyment of life. It goes beyond just a little extra down to feeling quite sad, maybe hopeless, and having a more difficult time enjoying usual activities. That difficulty finding enjoyment with usual activities can also come across as having difficulty concentrating on things like reading, watching TV, or other activities that were not difficult for the person to do before. 

Often with winter pattern depression, we see people eat much more than usual, especially high carbohydrates foods. They often sleep much more than normal which gets in the way of doing other activities. 

People will also socially isolate. Poor weather and a lack of outdoor activities makes social isolation much easier in the winter than other times of year. It’s not unusual to not want to go out when it’s cold and uncomfortable out. However, for people with SAD, this is often hiding the bigger issue in that the isolation is being fueled by depression. 

What can we do? Winter blues.

The general idea of trying to stay on top of the winter blues is pretty similar to SAD. Self-care is one of the biggest things that can contribute to feeling better during the winter months. Now, depending on if you’re experiencing the winter blues or seasonal depression, some aspects of this self-care could look quite different. But the general idea is very similar. 

For the winter blues, especially, it’s important to keep as normal a routine as possible. A lot of the general down feeling we get from winter comes from the disruption in our routines and activities we love. If you like being active, try finding a way to make outdoor activities more comfortable for you in the winter or find a new indoor activity to try instead. Try continuing with your regular socializing and keep yourself to a consistent sleep schedule. It can be hard to want to stay awake until your normal sleep time of 10pm if it gets dark at 4pm. For many of us, our brains are partially wired to associate sunset with getting ready for bed!

General mindfulness can also be very helpful. The self-awareness and insight that comes from practicing mindfulness can help us stay ahead of these kinds of feelings. Often we can stop a cycle from progressing further if we notice it in the beginning stages. Mindfulness can help with that!

Of course enjoy all those holiday specialities you love. There’s no reason not to eat your favorite dessert but also make sure to keep eating balanced, nutritious meals. When we feel better physically, it can help boost how we feel mentally, too!

Get out and enjoy some vitamin D! We get it from the sun and while there’s less of it available in the winter, we can still get it by having short periods of time outside. Don’t just take a supplement without doctor’s guidance, though. Not everyone needs to supplement vitamin D!

What about for SAD?

For seasonal depression, all of those tips above are great. They may be difficult to keep up with, as major depressive disorder can be pretty disruptive to people’s lives sometimes, but it’s important to try. Something that could help is to also coordinate with your care team to start an antidepressant (or increase the dose) temporarily a few weeks before your symptoms usually begin. With SAD, it can help to have that little bit of extra help, chemically, to get through the worst of the symptoms. This has been found to be a pretty effective treatment for SAD. Towards the end of when your usual symptoms are present, you can discontinue the medication or go back down to your normal dose (again, all with your care team’s guidance). 

Something else that can help is therapy. Cognitive behavioral therapy (CBT) is one of the most well known forms of therapy these days. Most importantly, there is a form of it that has been specially designed for seasonal depression. CBT-SAD has been shown to be an effective treatment for SAD, both winter and summer, and can make a big difference for how people experience these seasons. 

What else should we know?

We know a lot more about how the winter tends to affect people than the summer. And to an extent, it is socially normal and expected that winter will bring with it some form of feeling down. However, if you’re struggling with keeping up with your daily routines and you feel you need help, reach out to a doctor or a therapist. Even if you just need to talk to someone during the winter, it can really help. 

Winter can be dark and dreary, but we don’t have to feel that way all the time ourselves. 

Resources:

https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651

https://mentalhealthcommission.ca/blog-posts/34590-seven-ways-to-cope-with-the-winter-blues

https://newsinhealth.nih.gov/2013/01/beat-winter-blues

https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder

https://www.nhsinform.scot/illnesses-and-conditions/mental-health/seasonal-affective-disorder-sad

https://www.verywellmind.com/how-to-beat-the-winter-blues-5087998

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Why Practice Self-Compassion?

How often do you beat yourself up mentally over mistakes, big or small? If you’re like most people, the answer is “at least sometimes”. For some people, it’s more often. And for others, it’s all the time. The problem with this type of approach to things is that it often doesn’t do much other than make us feel worse. Self-compassion, however, can be a good alternative to this reaction to mistakes, failings, or bad things that sometimes just happen to us. 

What is Self-Compassion?

In the most simple of terms, self-compassion is kindness and understanding that you extend to yourself. The type of comfort you would give to a friend, even in the face of a serious mistake, would be the same comfort you would give to yourself through self-compassion. It’s care that you give to yourself in moments of pain or suffering, or even fear through acceptance of the situation as it is. 

According to Dr. Kristen Neff, an expert on self-compassion, self-compassion is made up of three main components: self-kindness, common humanity, and mindfulness. 

Self-kindness involves supporting ourselves with warmth and comfort through difficult moments we may otherwise be self-critical during. We approach ourselves with a helpful mindframe instead of a cold one. This sometimes is the most difficult part of self-compassion because many of us are actively taught to be very critical of our mistakes.

Common humanity is the understanding that we are not alone and that many people in the world throughout time have dealt with these situations and feelings. Often, when something bad happens to us, we can feel as if we’re the only ones who could have such poor luck. Or that maybe no one could possibly understand how badly we feel about something. Recognizing that others suffer, too, can help us put things into perspective. This is not the same as minimizing or invalidating our feelings by saying “well, other people have it worse so I should suck it up”. It’s saying to ourselves, “other people have dealt with this, too, and I’m not alone in these feelings”.

Mindfulness encourages us to pause and look at the situation through a different perspective. It involves approaching things with acceptance and turning our pain into something more productive through this acceptance. It makes us stop and think about things without attaching moral judgements on them. 

What is it NOT?

Self-compassion is not the same as being indulgent, flippant, or selfish. It does not involve just shrugging off mistakes and the harm they could be causing to ourselves and others. Self-compassion doesn’t mean refusing to feel badly about something or refusing to take accountability for it. There is a misconception that being kind to ourselves in moments of difficulty, even if we are the cause of the difficulty, will lead us to being lax and not working to fix things. 

People often assume that being hard on ourselves and being super critical is how we push for change. However, that’s counterintuitive. Shame is very rarely an effective motivator for people and often has the opposite effect. We don’t want to handle issues that we’re ashamed of and we want to avoid those feelings as much as possible. Being self-critical can also make us feel much worse than the initial event did. This can make us disheartened and also cause us to lack motivation entirely. 

Self-compassion, however, encourages us to take responsibility, accept that the situation is what it is, and understand that we are not failures or bad people just because we made a mistake or something bad happened. It asks that we speak to ourselves gently, like we would with a friend. 

What would you say to a loved one? Often, the things we say to ourselves are things we would never say to our friends, partners, children, or anyone else we care about. So why do we think it’s okay to say them in our heads? Self-compassion encourages us to use the same approach to ourselves that we would with a loved one, even when they mess up. 

How do we Practice Self-Compassion?

Accept that you make mistakes! This can be really difficult to do, but it’s the first step to really practicing self-compassion. It also makes it easier to talk to yourself in a more gentle, kind way. 

Work on self-awareness of inner dialogues. A lot of the time, our responses and internal dialogue are based on deeply ingrained beliefs taught us to us by society, friends, and family. Becoming aware of what our self-talk really looks like is an important aspect of turning it into something kinder. 

Work on mindfulness! It’s a big part of the process because so often, we just rush from moment to moment and thought to thought. We have a hard time living in the right now, especially if right now is hard or painful. Sitting with those feelings, however, is important. It’s also important to understand that these feelings are temporary. 

Want to know more? Check out Dr. Kristen Neff’s guided practices on self-compassion! Her work into self-compassion has really broadened our understanding of it and her website is full of great resources for those looking to know more or get a starting point.

It can be hard to get started on this sort of thing on your own. If you feel your negative self-talk is having a detrimental effect on your life and you’d like to work on it, consider reaching out to a therapist. Often, they can help with gaining insight and practicing mindfulness that can help turn self-criticism into self-compassion. 

Resources

https://www.mindful.org/the-transformative-effects-of-mindful-self-compassion

https://positivepsychology.com/how-to-practice-self-compassion

https://self-compassion.org/self-compassion-practices/#guided-practices

Be Kind To Your Mind: Practicing Self-Compassion
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How Can We Sleep Better? Try Working on Sleep Hygiene

We spent the previous two posts discussing sleep disorders. However, what about those who need a bit more help getting better sleep but don’t have a diagnosed sleep disorder? Something that can help is practicing good sleep hygiene. 

What is Sleep Hygiene?

Sleep hygiene is essentially a set of behaviors that someone does to try and promote good sleep. For example, this could be something like having a set routine every night at the same time as a way of triggering your brain to know that it’s time to start winding down for sleep. It can also be how you use your room and the temperature you set it to. Not only this, but sleep hygiene can involve daytime habits as well that can pay off later on for better sleep overall. 

The reason practicing good sleep hygiene is so important is because it can help you really get into the habit of taking care of and prioritizing your sleep. Many of us just don’t get enough sleep and often the sleep we do get isn’t the greatest quality. Lack of sleep can contribute to anxiety, depression, irritability, and can even make some tasks, like driving, more dangerous. Thinking about your sleep routine and other habits can help you pinpoint where things may be going wrong and getting in the way of the best sleep you could be having.

Sleep Hygiene Tips:

Some Sleep Hygiene Tips

  • Avoid using your room, especially your bed, for things other than sex
  • Exercise regularly, but not right before bed
  • Have a regular sleep cycle. Go to bed around the same time and wake up around the same time every day, even on weekends
  • Don’t eat large meals before bed. Small snacks can help keep you from getting hungry during the night
  • No caffeine, nicotine, or alcohol about 4-6 hours before bed
  • Try to taper off your drinks before bed. This can help avoid you getting up in the middle of the night to go to the bathroom.
  • If you can’t fall asleep within 20 minutes, go to another room and do something relaxing until you feel drowsy again. Then try going back to sleep
  • Start winding down about an hour before expected bedtime. This includes not using bright lights or electronics
  • If your phone is too tempting, try keeping it in another room or at least not within easy reach of your bed
    • Consider turning off notifications or keeping your phone screen down so it doesn’t wake you in the night
  • Keep your room a comfortable temperature, whatever that means for you
  • Try some relaxation techniques, like meditation, in order to help you calm down

Of course, as we know, there are things out of our control that can interfere with good sleep. Sleep disorders can make it difficult to sleep regardless of your sleep routines and at that point you would need the help of a sleep professional (like a doctor who specializes in sleep disorders) or a therapist, depending on what exactly is keeping you from being able to sleep well. Therapy can also help if you’re finding you’re having a hard time in implementing routine changes. 

Hopefully this post can help you on the road to getting more, and better, sleep!

Resources:

https://www.cci.health.wa.gov.au/~/media/CCI/Mental-Health-Professionals/Sleep/Sleep—Information-Sheets/Sleep-Information-Sheet—04—Sleep-Hygiene.pdf

https://health.clevelandclinic.org/sleep-hygiene

https://www.headspace.com/sleep/sleep-hygiene

https://www.ncbi.nlm.nih.gov/books/NBK279320

https://sleepeducation.org/healthy-sleep/healthy-sleep-habits

https://www.ucsfhealth.org/education/improve-your-sleep-hygiene

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Sleep Disorders: The Things That Keep Us Awake Pt.2

In our previous post, we discussed three common types of sleep disorders, their symptoms, and treatments. There are over 70 known sleep disorders that are recognized though some say there could be more than 100. Often, sleep disorders are broken down into six main types: circadian rhythm sleep-wake disorders, insomnia, hypersomnia disorders, parasomnias, sleep-related breathing disorders, and sleep-related movement disorders. In our previous post, we talked about circadian rhythm sleep-wake disorders, insomnia, and hypersomnia disorders. This post will be dedicated to parasomnias, sleep-related breathing disorders, and sleep-related movement disorders. 

Parasomnias

Parasomnias are incredibly common and most people experience at least one of them during their lives. They are considered unwanted experiences during sleep that are not controllable by the person experiencing them. Parasomnias are not well understood as to what exactly causes them or any particular risk factors overall, but mood disorders and substance use seems to increase risk for some parasomnias but not others. Many parasomnias resolve on their own over time, which is especially true for children. Parasomnias are very common in children but as they age, the sleep disorders tend to disappear. 

Sleep eating disorder and hallucinations

Sleep eating disorder is a parasomnia disorder that involves a person eating while sleeping. This is different from someone who eats excessively after bedtime while aware. An individual experiencing this parasomnia is not aware of what is happening. This can be distressing for the person experiencing it because of the lack of awareness or memory around the event. 

A very common sleep disorder is hallucinations that happen right when falling asleep or as someone is waking up. Usually these are visual hallucinations but they can also be sensory or auditory hallucinations. They can sometimes be distressing for the person experiencing them, especially if they occur with sleep paralysis. Often these hallucinations are so vivid it is difficult for the person experiencing them to be able to tell if they are dreaming or not.

Sleep paralysis and night terrors

Sleep paralysis is another common sleep disorder that often is paired with others, like sleep hallucinations and narcolepsy. This disorder can be very distressing for the individual because it involves an inability to move the body or speak while being aware and conscious. If paired with hallucinations, it can be especially upsetting. The paralysis goes away on its own as the person wakes more and more but sometimes an individual can speed this process up by making extreme efforts to move.

Night terrors, or sleep terrors, are a well-known sleep disorder that involves the person sitting up in bed, while asleep, and screaming or thrashing around. Often, the person will be very difficult to wake up and may not recognize where they are or who is around them. When they do wake, many individuals are very confused and disoriented and may still be afraid. Very often, they do not remember what they were dreaming about or what caused the night terrors. 

Sleep Walking

Sleep walking is a commonly occuring parasomnia in which the individual will leave bed while asleep and walk around. Sometimes this can just involve walking around the home but can sometimes be dangerous, for example if the person gets into a car to drive or if there is an open window on a second or higher floor. On occasion, the person can end up doing things that are not appropriate within their context (such as urinating in a closet). Often, it is better to gently guide the individual back to bed instead of trying to wake them up. This is especially true for children. If you know a child in your home sleepwalks, make sure that all doors and windows are locked in order to keep them from leaving the home while sleepwalking. 

Sleep Apneas

Sleep-related breathing disorders are something many people have heard about but perhaps do not associate them with being sleep disorders. Obstructive sleep apnea is the most well-known by the general public, though there are others, such as central sleep apnea or infant or child sleep apnea. Groaning, snoring, and other related noises during sleep are also considered sleep-related breathing disorders when they occur on their own. In this post, we’ll focus on obstructive sleep apnea as it’s the most likely one that people will encounter. 

Obstructive sleep apnea is a disorder in which there is an anatomical issue that is obstructing the airway of an individual while they sleep. This can be excess tissue in the neck or throat, a tongue that falls back, or enlarged tonsils. These obstructions cause the person to temporarily stop breathing in their sleep. This is often characterized by snoring, gasping, choking noises, or being woken up by the inability to breathe. However, the person usually does not remember waking up due to this. More commonly, it is the bed partner who notices these symptoms and encourages the individual to pursue treatment. It can happen either a few times a night or even a few hundred in extreme cases. 

It is diagnosed by a sleep doctor, usually with an at home sleep apnea test or in a sleep lab. 

Obstructive sleep apnea can have very negative consequences on an individual’s health, which highlights the importance of early diagnosis and treatment. These are related to the lack of oxygen that the person experiences during the night and include: high blood pressure and higher heart disease risk, depression, stroke, and diabetes. 

Symptoms of Obstructive Sleep Apnea

Symptoms of obstructive sleep apnea include:

  • Loud or frequent snoring
  • Silent pauses in breathing
  • Choking or gasping sounds
  • Daytime sleepiness or fatigue
  • Unrefreshing or restless sleep
  • Insomnia
  • Morning headaches
  • Waking frequently during the night to go to the bathroom
  • Difficulty concentrating
  • Memory loss
  • Decreased sexual desire
  • Difficulty maintaining an erection
  • Irritability

There are effective treatments for obstructive sleep apnea. The first line treatment for this disorder is the use of a continuous positive airway pressure (CPAP) machine. This is a machine that uses gentle bursts of air to keep the airway open while the individual sleeps. If the CPAP is not a good fit for an individual, a doctor may recommend the use of oral appliance therapy which is a device that fits in the mouth that holds the tongue in place and keeps the airway from collapsing and looks like a retainer or sports guard. For very severe cases that do not respond to these treatments, surgery may be used to remove some of the excess tissue that is contributing to the obstruction. 

Sleep Related Movement Disorders

The final type of sleep disorder we’re going to discuss is the category of sleep-related movement disorders. The most well-known of these is restless leg syndrome, or RLS. RLS is characterized by an urge to move the legs or an uncomfortable feeling in the legs while lying down or resting. It often makes it difficult for someone to fall asleep. Some people describe the feeling as a crawling sensation in the legs. This can also make it difficult for someone to sit down for long periods of time, such as in a car or at work. 

RLS very commonly starts after the age of 40, but can affect people of any age. It is twice as common in people assigned female at birth. Some causes of RLS are low iron levels, diabetes, pregnancy, some medications, and can be sometimes linked to kidney problems (such as kidney failure). 

This condition is often managed with medication. 

Sleep Starts

Sleep starts are a sleep-related movement disorder that many people do not think of when they think about sleep disorders. It’s something that almost everyone will experience at least once in their lives. Most people compare it to a sense of falling while either going to sleep or waking up. Sleep starts or sleep jerks are caused by the major muscles in the body suddenly contracting all at once. This is usually not a problem for many people but for those who experience it often, or who become anxious due to sleep starts, this may contribute to insomnia. It can also sometimes cause injury if the individual hits a piece of furniture or a bed partner during a sleep start or jerk. They rarely need treatment or management but if they are causing distress or issues for the person experiencing them, they can be managed by reducing stress, making sure to get enough sleep, and avoiding stimulants (like caffeine). 

One of the best ways of dealing with many sleep disorders or to just get better sleep in general is to focus on sleep hygiene and getting a regular bedtime routine. Our next post will discuss the ways in which you can contribute to having better sleep!

Feel you may need help with a sleep disorder? Look at our list of clinicians and see if you’d like to make an appointment with us!

Resources:

https://www.ncbi.nlm.nih.gov/books/NBK560720

https://www.nccih.nih.gov/health/sleep-disorders-what-you-need-to-know

https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders

https://sleepeducation.org/sleep-disorders

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Sleep Disorders: The Things That Keep us Awake Pt.1

Sleep disorders are more common than people think and most people experience one or more sleep disorders at least once in their lives. There are over 70 known sleep disorders that are recognized though some say there could be more than 100. Sleep disorders are especially common in children, though they commonly self-resolve with age, and adults over 65. Often, sleep disorders are broken down into six main types: circadian rhythm sleep-wake disorders, insomnia, hypersomnia disorders, parasomnias, sleep-related breathing disorders, and sleep-related movement disorders. In this post, we’ll be discussing circadian rhythm sleep-wake disorders, insomnia, and hypersomnia disorders. 

Sleep-Wake Disorders

Circadian rhythm sleep-wake disorders are characterized by some kind of interruption in the natural circadian sleep cycle. For example, we see this often with people who do shift work or have unpredictable work hours, and we often see this affecting people who have traveled from one time zone to another (jet lag). Less common forms of this sleep disorder are delayed sleep-wake disorder or advanced sleep-wake disorder. For those experiencing this disorder due to shift work, unfortunately the only way to really treat this is to have a more predictable work schedule. Having a regular sleep-wake cycle is the best way to deal with this type of sleep disorder, however that is not always an option for everyone. 

Insomnia

Insomnia is the most well known sleep disorder with most people experiencing at least one episode of insomnia during their lifetime. It can be short term or it can be chronic. Chronic insomnia is diagnosed after a period of three months, with at least three instances of insomnia a week. It can involve delayed sleep onset (30 minutes or more to fall asleep), poor sleep maintenance (waking and being unable to fall back asleep after 30 minutes or more), or a combination of both. It can be very disruptive to a person’s life, involving the following symptoms or outcomes:

  • Irritability
  • Daytime sleepiness
  • Brain fog
  • Attention issues
  • More likelihood of mistakes while at work or driving
  • Can interfere with work or relationships

Insomnia can be related to many things and have many root causes. For example, it could be related to mood disorders, other mental health disorders, chronic illness, stress, or some medications. Alcohol, caffeine, or nicotine use (or other drug use), especially in the evening, can also contribute to insomnia. 

However, insomnia is also very treatable! Lifestyle changes are usually the first recommendation, such as avoiding caffeine in the evening or avoiding naps. However, CBT-I is also an effective treatment for insomnia. CBT-I is cognitive behavioral therapy for insomnia and can help treat insomnia for those who have suffered with very long term chronic insomnia. 

Hypersomnia

In contrast, hypersomnia sleep disorders involve excessive sleepiness. The most well-known form of hypersomnia is narcolepsy, but there are other disorders in this category, such as Kleine-Levin syndrome and insufficient sleep syndrome. The important thing to note is that those with hypersomnia do not necessarily sleep more than the average population when it comes to total hours of sleep. However, the sleep they do get is rarely refreshing, causing intense fatigue. 

Narcolepsy is a neurological disorder that disrupts the sleep-wake cycle. It is characterized by extreme bouts of sleepiness. For some people, it can also involve sudden muscle weakness, especially during times of intense emotion (even when laughing!) known as cataplexy. Cataplexy can be dangerous because it can happen while driving or working, which can open up the possibility for serious injury. 

While someone with narcolepsy may feel refreshed immediately after sleeping or taking a nap, the individual will soon become fatigued again and not feel rested. Other common symptoms of narcolepsy are sleep hallucinations, sleep paralysis, and issues with memory. 

Thankfully, narcolepsy is treatable. Available treatments for narcolepsy include:

  • Stimulants – This is the first line of treatment for most people
  • SSRIs
  • Sodium oxybate (a medication for daytime sleepiness and cataplexy)
  • Maintaining a consistent sleep-wake schedule
  • Scheduling short, 20-minute naps through the day
  • Regular exercise
  • Avoid alcohol, tobacco, and other drugs, especially in the evenings

Narcolepsy does not seem to have a hereditary component. Another recommendation for those who have narcolepsy is to seek accommodations at work or school. Narcolepsy is recognized by the ADA and a documented case of narcolepsy as diagnosed by a doctor must be accommodated in work or school settings within reason. Always discuss with a doctor what the options for these accommodations would be. 

While these disorders are something most people experience, if they ever become a problem for you or someone you know, seek out help from a doctor or other professional (such as a therapist familiar with CBT-I in an insomnia case, for example) in order to treat them. Sleep disorders are often very treatable and many of the more disruptive symptoms can be dealt with under proper care. 

Resources

https://www.ncbi.nlm.nih.gov/books/NBK560720

https://www.nccih.nih.gov/health/sleep-disorders-what-you-need-to-know

https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders

https://sleepeducation.org/sleep-disorders

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Taking Care of Your Mental Health

Our past few posts have been about various mental health topics, from compassion fatigue to major depressive disorder and more. While those were all more specialized posts, there is also a need to consider why it’s important to focus on overall mental health. Not everyone has a diagnosable mental health disorder but everyone should be taking steps to care for their mental health in order to have the best quality of life. 

Of course, there are things you can do to take care of yourself when you’re experiencing extra stress or something distressing. Going to therapy, joining support groups, and reaching out to other sources of support, like a spiritual or religious leader, are all great options for everyone, along with medication when needed. But what about dealing with everyday stressors or concerns, like a bad few days at work or a fight with a loved one? 

Importance of Self-Care for Mental Health

Keeping ourselves healthy physically is something we hear about all the time. Eating well, moving often, and resting when needed are all pieces of that puzzle. Mental health is also part of that puzzle. Self-care is something we talked about more in-depth in the compassion fatigue and clinician mental health post, it’s also something the other posts have mentioned here and there. 

It can be difficult to make time for things like self-care. Sometimes even 5 minutes can feel impossible to find. But any attempt to add any kind of self-care you can manage is important. The social media version of self-care makes us believe that we need to do something super involved, possibly expensive, and often time-consuming. We think of spa days, lengthy skin-care routines, going on vacations, or any other number of big things that we’re told to do to “take care of ourselves”. Of course, all of these things are nice, and taking vacations can be important, but self-care can be much more manageable and doable on an everyday basis. Self-care can look like face masks and skin care, or it can look like just having a cup of tea or coffee by yourself while you just take time to sit quietly and unwind.

Types of Self-Care

Self-care can also look like watching your favorite TV show or movie, reading a few pages in a book, eating a delicious meal, or even just lighting a candle or using a diffuser to set a calming atmosphere in your home. It can also include cleaning your home and making sure you have a safe, healthy space to live in. Self-care is incredibly customizable and can be done in so many little ways or big ways that can add to our quality of life and help support our overall mental health.

While there is often a push that self-care is something that we do alone, and that is absolutely a valid option, the importance of social support shouldn’t be overlooked. Reach out to friends, family, or even join community groups. Volunteering can also be something that can help support our mental health, as helping others can help us to feel good and give us meaning, two important components of mental health.

Half of mental health care is preventative care, much like with physical health. Being able to have these habits and routines in place can help us get through some of the more stressful moments in our lives before we reach a crisis point. It can also be added to a more traditional mental health treatment program, such as therapy or medication, to help increase the effectiveness of the treatment. 

Reminders and Wrap-up

It also cannot be understated how much physical health can affect mental health. Exercising regularly, even if it’s just a short walk outside, can help with stress and other everyday mental health needs we all have. Eating balanced, nutritious meals along with our favorite, comfort foods is a great way to keep ourselves healthy both physically and mentally. Cutting out entire food groups or types is not recommended unless under the supervision of a medical doctor.

Taking a few extra minutes every day can go a long way to supporting your overall mental health. While there is no expectation that you could, or would want to, try everything listed in this post, we hope that it may have given you a starting point for how to add a little extra care for yourself everyday. 

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Post-Traumatic Stress Disorder Can Affect Anyone

May was Mental Health Awareness Month and on our socials, we shared information about different mental health topics throughout last month. These blog posts are part of a series where we expand on those topics and offer more information. 

Post-traumatic stress disorder, more commonly known as PTSD, is a mental health disorder that develops as a response to a traumatic event. Currently, we’re not sure what exactly causes PTSD, as most people who experience trauma do not develop PTSD. We do know that people who were assigned female at birth are much more likely to develop PTSD than those who were assigned male at birth. We also have current statistics for PTSD: 3.6% of the US adult population has PTSD with 37% of those with PTSD having severe symptoms. It usually develops within months of the traumatic event and symptoms can last months, years, or even be life-long. Treatment is critical for helping to manage these systems. 

Traumatic events that have been linked to development of PTSD are: sexual assault, abuse, witnessing a death, combat/war, terrorist attacks, being in an accident, and even experiencing the trauma of a loved one second hand. 

Often, the symptoms are broken down into four main categories: re-experiencing, avoidance, cognitive/mood, and arousal. 

Re-experiencing:

  • Recurring, intrusive thoughts about the event
  • Flashbacks
  • Bad dreams
  • Intrusive memories
  • Avoidance:
    • Avoiding the place where it happened
    • Avoiding people who remind you of the event
    • Avoiding objects or other things that remind you of the event
  • Cognitive/Mood:
    • Memory problems related to the event
    • Negative self-image or thoughts
    • Guilt or shame
    • Numbness or depression
    • Anxiety
    • Derealization
    • Dissociation
  • Arousal:
    • Hypervigilance
    • Easily startled
    • Difficulty concentrating
    • Sleep disturbances
    • Irritability

Children have also been diagnosed with PTSD and we often see them develop it in response to many of the same situations that adults do. However, they can show some different symptoms such as:

  • Regression (for example, a toilet-trained child suddenly wetting the bed)
  • Unusual and sudden clinginess (usually to a parent or another trusted adult)
  • Re-enacting the traumatic events through play

Early diagnosis and treatment is critical for the best possible outcome for an individual with PTSD. This can help with reducing the severity of symptoms or even eliminating some of them entirely. Treatment can help the individual get back to a healthy level of everyday functioning and help them manage symptoms such as nightmares, flashbacks, and many of the other distressing symptoms of PTSD.

Treatments generally include medications, such as SSRIs, and therapy. Therapy usually consists of some form of CBT (like exposure therapy and recognitive structuring) and EMDR. Learning self-management techniques is also critical to successful therapy, such as the ability to self-soothe and use mindfulness strategies. 

PTSD can co-occur with other disorders like depression, OCD, panic disorder, and substance use disorder. Often, treating these disorders co-currently is the best way to see improvement, as PTSD improves with the treatment of OCD, for example, and OCD improves with the treatment of PTSD.

Want help with PTSD? Look at our list of clinicians and contact us to book an appointment.

Resources:

https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Posttraumatic-Stress-Disorder

https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

https://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd#part_6135

https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

https://www.samhsa.gov/mental-health/post-traumatic-stress-disorder

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Summer Isn’t the Best Time For Everyone: Summer SAD

In our previous post, we discussed the mental health benefits of summer. While there are many benefits of summer for the majority of people, some people experience more mental health difficulties during summer. Most people have heard of SAD, seasonal affective disorder, and the assumption is that it always affects people during the winter. However, some people have SAD in the summer. 

Seasonal affective disorder is more formally known as major depressive disorder with a seasonal pattern. This means that the symptoms of depression come at predictable times seasonally. For the majority of people with SAD, symptoms start in the fall, get more severe during winter, and then resolve by the beginning of spring. However, about 10% of those with SAD experience symptoms starting in late spring which get more severe during summer and then resolve by early fall. 

Major Depression or SAD?

The existence of a predictable pattern is what makes it distinctly different from major depressive disorder (MDD). MDD often does not have a specific pattern of onset of symptoms. Not only must the symptoms be seasonal but this pattern needs to exist for a minimum of 2 years in order for someone to be diagnosed with SAD as opposed to MDD or another mood disorder. 

SAD is well researched, but the majority of research is for the winter pattern. There is little research about summer pattern SAD, which means we don’t know nearly as much about it. What we do know, is that it shares many of the same symptoms of winter pattern SAD, with a few exceptions. Instead of eating more than usual (especially carbohydrates) as is common in winter pattern SAD, summer pattern usually comes with decreased appetite. This means that people often lose weight as opposed to gaining weight. Summer pattern SAD also comes with more irritability and insomnia, as opposed to hypersomnia (oversleeping) common in winter depression. 

There are also some studies that suggest potential triggers for summer pattern SAD. One potential trigger is pollen. Summer depression seems to be more common in those who have seasonal allergies triggered by pollen, which is more common in the spring and summer. Another trigger could be the heat and especially high humidity. Summer pattern SAD seems to be more common in countries that experience high humidity, which suggests this link. There also could be a link between more sunlight and longer days. It’s possible that in those who experience summer SAD that they’re more sensitive to circadian rhythm changes due to the sun. This could be what causes the insomnia many people with summer pattern SAD experience. 

Treatment Options

Unlike with winter SAD, we don’t really have specialized treatments for summer pattern SAD. We do know that SSRIs and SNRIs are effective treatments for summer SAD, especially when started 4-6 weeks before the usual onset of symptoms and then discontinued at the end of summer. There is a form of CBT that has been developed specifically for those with seasonal pattern depression called CBT-SAD and that has been effective for treating summer depression, as well. Other suggestions have been to stay out of the heat and sun as much as possible (no more than 30 minutes to an hour), being in air conditioned spaces if possible, and to keep one’s bedroom dark. Going to bed right after sunset and sleeping in a dark room can help offset some of the disturbances the longer days can cause to sleep patterns.

Another suggestion is to try and maintain a normal routine as much as possible. This helps with avoiding the isolation that can come from depression symptoms. Exercise and maintaining a nutritious diet can also help with relieving the severity of symptoms. 

While we may not know as much about summer pattern depression as we do about winter, we do know that it exists. If you’re one of those people who experience seasonal depression in the summer, you’re not alone. And there are effective treatment options out there. Hopefully over time, more research will be done on this form of depression and we’ll know even more about it and how best to treat it. 

Resources:

https://health.clevelandclinic.org/summer-depression

https://www.healthcentral.com/condition/depression/summer-seasonal-affective-disorder?legacy=psycom

https://www.healthline.com/health-news/seasonal-affective-disorder-can-affect-you-in-the-summer-too#Ways-to-combat-summer-SAD-symptoms

https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder

Could Summer Depression Be Seasonal Affective Disorder?

https://www.smithsonianmag.com/science-nature/people-get-seasonal-depression-summer-too-180955673

https://www.verywellmind.com/summer-depression-symptoms-risk-factors-diagnosis-treatment-and-coping-4768191

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