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Fri, Oct. 18

Treating sleep apnea can ease mood disorders

Dear Dr. Rosenberg,

I am a 42-year-old woman who suffers from Generalized Anxiety Disorder (GAD). My husband says I snore but not loudly. My psychiatrist thinks I should get a sleep study to see if I have sleep apnea. She says it could be contributing to my anxiety. Is that possible?

A: Yes it is. A study published recently showed sleep apnea affected women's brains differently than men's. There were more changes in what is referred to as white matter. This was noted especially in an area of the brain involved in mood regulation and decision making, called the cingulum. So what your psychiatrist is suggesting does make sense. I have had numerous patients whose mood or anxiety disorders improved with treatment of their sleep disorder.

Dear Dr. Rosenberg,

I have atrial fibrillation. I have had two cardioversions and after each one I went back into atrial fibrillation after a few weeks. I snore and now my cardiologist wants me to get a sleep study. He says that may be why the shock treatments to my heart have not worked. What do you think?

A: I think your cardiologist is correct. We know that sleep apnea is a major cause of atrial fibrillation. However, we now know that if untreated, it is also a major cause of recurrence of the condition after cardioversion. I would urge you to get studied. If you have sleep apnea and are successfully cardioverted you may be able to avoid a lifetime of being on anticoagulants.

Dear Dr. Rosenberg,

I have had restless legs for several years. I have been using a medication called Requip successfully until this month. The pain is coming on earlier in the day and is more intense. My doctor raised the dose of Requip and even had me take a dose earlier but it's not working. Do you have any ideas?

A: Yes, what you are describing is called augmentation. It is characterized by earlier and worsening symptoms that may even involve parts of the body other than the legs. It occurs in about 30 percent of people on medications such as Requip, which are dopaminergic medications. Treatment usually involves switching to a different drug in the same family as Requip, or changing medication types all together. I have had some excellent results with switching my patients to a trans-dermal form of a medication called Rotigotine (Neupro Patch). It is a dopaminergic agent that releases a constant level of the medication through the skin over 24 hours. You might want to discuss this with your doctor.

Dear Dr. Rosenberg,

My granddaughter, now 12, has ongoing sleep issues. She has trouble going to bed on her own, and wakes up in the middle of the night afraid and wanting to get into bed with her parents. For the first 3 years of her life she slept in her parents' bed. Do you think her issues are related to the fact that she did not learn to self-soothe as an infant/toddler?

A: Yes, I do. This is what happens in many children when their BIC (Behaviorally Induced Childhood Insomnia) is not addressed. They tend to develop chronic insomnia. It sounds like she has persistent sleep onset association insomnia. She needs her parents' presence to fall asleep. However, at age 12, this may now be complicated by issues such as poor sleep hygiene, anxiety and/or depression. I would suggest your son or daughter discuss these sleep issues with their pediatrician.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him through the form at www.answersforsleep.com or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Drive, Prescott Valley, AZ 86314.

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