Welcome to Issue 295 of Institute Inbrief
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Issue 295 // Institute Inbrief
Dear Reader,

Welcome to Edition 295 of Institute Inbrief! Sleep and mental health disorders exist in bi-directional relationship with one another, meaning that each condition influences the other. In this edition's featured article we explore this relationship in more detail. 
 
Also in this edition:
  1. Mental Health Super Summit 2018
  2. Trauma: The Therapeutic Window
  3. A Case of Mid-Life Difficulties
  4. Naps: No More Bad Raps
  5. Quotations, Seminar Timetables & More!
Enjoy your reading!

AIPC Team. 
Diploma of Counselling
It’s time to start loving what you do!

We’ve been training qualified Counsellors for over 25 years. Overwhelmingly, the number one reason people cite as why they became a Counsellor – to start loving what they do. They were stuck in a rut doing something they had no passion for, and it was dragging them down.

If you want a deeper understanding of yourself, and to use that knowledge to assist others overcome their challenges and start enjoying life again – then counselling is likely for you.

Too often we get drawn into a career that offers little personal satisfaction. Counsellors are passionate about the important work they do. They’re often someone that friends and family naturally come to for assistance. And they get immense personal reward helping others.
 
If that sounds like you, then it’s time to start pursuing your passion:
  1. Learn about yourself and help others lead better lives
  2. Be employed in one of the fastest industry growth sectors in the nation
  3. Self-paced training, so you can fit learning around your life
  4. Flexible and supported training with quality learning materials

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AIPC's Community Services Courses
Helping You Help Your Community
 
We’ve helped people from all sorts of backgrounds become counsellors, and now we can assist you in fulfilling your goal of working within the Community Services sector! AIPC is delivering the following two new courses:
 
Diploma of Community Services (Case Management) – learn more
 
Diploma of Youth Work – learn more
 
There has never been a better time for you to become involved and invested in the Community Services industries. It is predicted, between the years of 2015 to 2019, that employment within the Health Care and Social Assistance industries will increase by 18.7% (www.lmip.gov.au, 2015).
 
By gaining a qualification in Community Services (Case Management) or Youth Work, you will be contributing to an industry that serves a very important purpose: to assist those with personal or relationship challenges. There is nothing more fulfilling than helping others overcome seemingly impossible obstacles. And there’s no better time to do that than now!

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Registration OPEN: Mental Health Super Summit
The Mental Health Super Summit is back... and it’s bigger and better than ever. AIPC is proud to support this event again.
 
Over the past 3 years, 6,500 mental health professionals have attended the Summit, raising $365,219.00 for the Act for Kids charity.
 
This year the event's target is to raise an inspiring $250,000.00 for charity.

Register now for the 2018 Mental Health Super Summit and you’ll learn directly from an international who’s who of renowned experts, including:
  1. Prof. Daniel J. Siegel (UCLA)
  2. Dr. Judith S. Beck (Beck Institute for CBT)
  3. Prof. Henry Brodaty AO (UNSW)
  4. Prof. Lea Waters (University of Melbourne)
  5. Prof. Isaac Prilleltensky (University of Miami)
  6. Dr. Justin Coulson (Happy Families)
  7. Dr. Michelle Segar (University of Michigan)
  8. Prof. Barry L. Jackson (Bloomsburg University of Pennsylvania)
  9. Dr. Reena Kotecha (Mindful Medics)
  10. Dr. Peter Parry (University of Queensland)
Remember, just like all the Summits, you choose what you pay to attend with all money raised going to charity.

If you’re a mental health practitioner or student, this event is not to be missed.
 
Learn more and register here: www.mentalhealthacademy.com.au/summit/2018
 
Got a question? Please contact the Mental Health Academy - the Summit's co-host & organiser - on help@mentalhealthacademy.com.au.
Mental Illness and Sleep Disorders
Sleep and mental health disorders exist in bi-directional relationship with one another, meaning that each condition influences the other. Clinicians say that this makes treatment challenging, but it is not impossible.  

There are some startling statistics that every mental health helper needs to pay attention to:

  1. About 40% of patients who seek medical help for sleeping problems have a psychiatric condition
     
  2. Around 80% of mental health patients have sleeping problems (as opposed to 10 to 18% of the general population (Tuck, 2018; Neurocore, 2017).
Years ago, sleep problems were thought of as just symptoms of mental health conditions, but scientific advances have shown us that they also contribute to or are even a cause of mental ill health (Tuck, 2018). The busy, electronics-heavy world we live in leaves us vulnerable to sleep disruptions as we extend our active phase of the day further and further into the evening with checking email or the latest social media posts on laptops and smartphones – or we watch just one more television show late into the night (all activities performed while we expose ourselves to the sleep-disturbing blue light of these devices). Adding in other life demands, sleep seems like a luxury that we think we’ll catch up on next weekend, or on our next holiday.

Unfortunately, healthy sleeping patterns don’t work that way, and the disruptions to sleep create an elevated risk for mental illness. This article is to give you a “heads-up” that, if you have a client presenting with one of these, they are likely to be experiencing the other as well, even if they haven’t told you about it. Sleep and mental health disorders exist in bi-directional relationship with one another, meaning that each condition influences the other. Clinicians say that this makes treatment challenging, but it is not impossible (Breus, 2016; Khawaja, 2017).

Changes to sleep architecture

People with mental health disorders often experience changes to what sleep specialists call their “sleep architecture”: that is, the pattern of movement of the brain and body between the different phases of sleep, from light sleep, through REM (rapid eye-movement) sleep, where we mostly dream, to deep sleep, and then cycling back to other stages throughout the night. Individuals whose sleep is disordered may not get enough total sleep, but even if their number of hours “horizontal” is sufficient, they may not spend enough time in the deep and REM stages.

The lack of (decent) sleep makes it more challenging to cope with the symptoms of their mental illness. REM sleep balances us emotionally, assisting in the ability to regulate emotions and make good judgments. We process information as we should. Without REM sleep, we are moodier, more prone to irrationality, and we have difficulty recalling things: obviously challenging when one already has a mental health condition! (Tuck, 2018).

Conditions closely related to sleep problems

ADHD (Attention Deficit Hyperactivity Disorder)

Both children and adults with ADHD experience sleep problems, with children experiencing more daytime tiredness and sleep-disordered breathing, and adults having symptoms similar to narcolepsy and hypersomnia (Breus, 2016).

Anxiety disorders

The heightened state of anxiety of those suffering from these disorders means that the nervous system is kept constantly on alert, as opposed to resetting back to normal after an anxiety-producing experience, as it does for those without anxiety disorders. The hormones connected with the acute anxiety – especially cortisol – are exactly the opposite of the melatonin the body needs to produce in order to induce sleep. The results are either insomnia (difficulty falling or staying asleep) or hypersomnia (oversleeping). With PTSD, individuals have a higher frequency of nightmares and nocturnal panic attacks (with similar symptoms to daytime panic attacks except that they occur during non-REM sleep) (Tuck, 2018).

Bipolar disorder

Sleep disorder is an integral aspect of bipolar disorder, in that during manic episodes, people feel very little need for sleep and during depressive episodes, they may experience insomnia as well as hypersomnia. Research shows that changes in sleep architecture accompany bipolar disorder: particularly variations to the timing and duration of REM sleep (Breus, 2018).

Depression

Sleep and depression have a love-hate relationship, with sleep disruption contributing to depressive symptoms and depression interfering with sleep. About 75% of people with depression also have insomnia, and those with chronic insomnia are five times more likely to develop depression (Breus, 2018). Also, those with obstructive sleep apnoea (OSA) are over five times more likely to have major depression (Tuck, 2018).

Schizophrenia and psychosis

The severe psychiatric condition of schizophrenia affects about 1% of the population; sufferers interpret reality abnormally, which often results in a combination of hallucinations, delusions, and extremely disordered thinking and behaviour impairing daily functioning. In addition, disturbances in sleep patterns occur to around 80% of people with schizophrenia. The sleep problems with this condition include:
  1. Circadian rhythm problems (misalignment with the time zone, as in jet lag)
  2. Taking longer to get to sleep
  3. Not getting enough sleep
  4. Waking frequently during sleep
  5. Sleep apnoea
Changes to sleep patterns can be an early signal of impending psychosis, and lack of sleep can increase the risk of psychosis and of paranoia (it can do this even in healthy adults) (Breus, 2018). Unfortunately, the irregular sleep patterns and hallucinations are sometimes side effects of medication for schizophrenia, and sleep quality as well as volume tends to be low (Tuck, 2018).

Treatments

Obviously, the first-line treatments for insomnia are good sleep hygiene, and taking care of underlying conditions causing problems with sleep. When both serious mental health issues and sleep disorders manifest together, this is easier said than done. Some of the treatments noted in the literature include:

CBT-I

For anxiety, ADHD, and bipolar disorder, cognitive behavioural therapy geared particularly for insomnia is indicated.

Medication

Some classes of anti-depressants help alleviate the depression and do not have side effects which disturb the sleep function. In terms of schizophrenia and psychosis, late-generation anti-psychotics such as clozapine, olanzapine, and quetiapine have been shown to have positive effects on sleep (where the first generation of anti-psychotics did not). Because psychiatric drugs are sometimes used to promote sleep in people with insomnia, clients must be careful not to become over-sedated by using other drugs or alcohol simultaneously.

Relaxation techniques

Techniques such as progressive muscle relaxation, deep breathing, mindfulness, and other forms of meditation help people to become aware of their body and decrease anxiety about going to sleep.

Herbal remedies

Melatonin and valerian are two popular herbal preparations widely available to help relax people for sleep, although the effectiveness of the treatments has not been proven for most people.

Sleep restriction

Used with bipolar disorder and other conditions where the individual is not tired enough, or tired at the right time, sleep restriction, in which the time an individual is allowed to lie in bed is tightly controlled (increasing over time), can be helpful to restore a more workable circadian rhythm.

Light therapy

We noted earlier that electronic devices emit a blue light, which gives the body the message that it’s time to wake up, and thus interferes with sleep when used at night. Blue light-blocking can be helpful here, such as through particular settings on some electronic devices, or glasses or goggles manufactured specifically to block the blue light. Also, phototherapy – bright light exposure early in the day -- can help people with delayed sleep phase syndrome (the night owl clients) by signalling to their brains that it is time to be awake and active.

CPAP and other sleeping devices

Equipment such as continuous positive airway pressure (CPAP) machines and dental splints to bring forward the lower jaw (thus opening the airway) can be helpful for those whose depression is being exacerbated by obstructive sleep apnoea.

Heavy blanket

For those ADHD sufferers who have restless leg syndrome, sleep experts recommend using a heavy blanket.

Exercise

This old standby is greatly helpful to most mental and physical health conditions; clients just need to be sure not to do it too late into the day (NAMI, 2018; Breus, 2016; Khawaja, 2017; Tuck, 2018)!

Summary

Either a sleep disorder or a mental health condition is difficult enough to deal with, but for the many people who have both, treatment is especially challenging. Conditions such as ADHD, anxiety disorders, bipolar disorder, depression, and schizophrenia/psychosis are particularly vulnerable to co-morbidity with sleep disorders, and as mental health professionals, we owe it to our clients to be on the lookout for one when a client is presenting with the other.
 


References

Breus, M. (2016). Sleep and mental health disorders. Psych Central. Retrieved on 31 July, 2018, from: Hyperlink.

Khawaja, I. (2017). Sleep disorders and mental illness go hand in hand. UT Southwestern Medical Center. Retrieved on 31 July, 2018, from: Hyperlink.

NAMI (National Alliance on Mental Illness). (2018). Sleep disorders: The connection between sleep and mental health. NAMI. Retrieved on 31 July, 2018, from: Hyperlink.  

Tuck. (2018). Mental illness and sleep disorders. Tuck. Retrieved on 1 August, 2018, from: Hyperlink.    
Trauma: The Therapeutic Window
If you had to endure a traumatic event – say, dangerous flooding, an out-of-control bushfire, or being caught up in terrorism – would you want to talk about your experiences later? Would you believe that it would help you to heal from them if you did? Early models for treating trauma asked clients to do this, insisting that the cure was in the retelling. Just around the millennium, however, research began to show that, while some people were helped by going over the trauma again with a counsellor or other “de-briefer”, many others’ trauma symptoms were exacerbated by the insistence on going over the event.

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A Case of Mid-Life Difficulties
Fritz is 42 years of age and has been in Australia for the past 25 years. He migrated from Germany with his immediate family, comprising of his mother, father and two sisters. At the age of 17 Fritz was filled with great dreams and aspirations for his new life in a new country and until recently had been quite happy with the life he had carved out for himself. Fritz has sought counselling largely due to the persistence of his wife. Fritz does not really understand why his wife is so upset with him but states that she thinks he is going through a “mid life crisis”.

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More articles: www.aipc.net.au/articles