The InterPsych Newsletter 2(3)



IPN 2(3) Section D: Research


                    SECTION D: RESEARCH

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| for collaborators. Until early '95, contributions         |
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                          * INDEX *

     1.   "The invisible epidemic of sleep apnea and snoring"
          by Jerry Halberstadt

     2.   Lists on the evaluation center at HSRI

1.         "The invisible epidemic of sleep apnea and snoring"
                            Jerry Halberstadt


Sleep apnea can cause symptoms of apparent clinical depression
which may respond quickly to treatment of the sleep disorder.
A knowledge of the intellectual and emotional impact of sleep
apnea may be important in making a correct diagnosis.
Unfortunately, many physicians, psychiatrists, and
psychologists may be unaware of this connection. Yet these
professions have much to contribute to dealing with this
problem and informed individuals can provide essential therapy
and support to the patient and the patient's family in the
recovery process.

The impact of sleep apnea and snoring on sleep and health in
the individual and for the public should not be ignored.
According the National Commission on Sleep Disorders Research:
"Forty million Americans are chronically ill with various
sleep disorders...Sleep apnea alone is the cause of excessive
daytime sleepiness experienced by almost 20 million
Americans... Overwhelming evidence from testimony and specific
surveys suggests that the vast majority of Americans with
sleep disorders remain undiagnosed and untreated. ... "
(Report of the National Commission on Sleep Disorders
Research, "Wake up America: A National Sleep Alert," Executive
Summary and Report, January 1993.)(hereafter cited as NCSDR)

What is sleep apnea?

"Obstructive sleep apnea is an illness characterized by
snoring, partial or complete cessation of breathing during
sleep, reductions in blood oxygen levels, severe sleep
fragmentation, and excessive daytime sleepiness. Researchers
and clinicians have recognized sleep apnea as one of the most
common sleep disorders and with perhaps the greatest medical
and social impact on society in terms of morbidity and
mortality. The syndrome strikes both sexes and all races,
ages, socioeconomic strata, and ethnic groups, though it is
less common in women prior to menopause, and may be more
common in blacks than in whites." (NCSDR)

"The potential consequences of obstructive sleep apnea are
significant and include hypertension, coronary heart disease,
myocardial infarction, pulmonary hypertension, congestive hear
failure, stroke, neuropsychiatric problems, cognitive
impairment, sexual disfunction, and injury due to accidents.
Finally the Commission estimates that cardiovascular deaths
attributable to obstructive sleep apnea alone may be as high
as 38,000 annually." (NCSDR)

"In the United States, 11,845,000 people between the ages of
30-60 are estimated to have obstructive sleep apnea; nearly
one-quarter of them (3,029,000) experience the disorder at a
moderate or severe level. The prevalence of obstructive sleep
apnea may be much higher in specific subgroups. ... For the
approximately 31 million Americans who are age 65 and older,
the best estimate of obstructive sleep apnea is 7,440,000,
with 46 percent at the moderate or severe level." (NCSDR)

Recent studies show that among employed people 30 to 60 years
old, at least 2 percent of the women and 4 percent of the men
may have treatable sleep apnea syndrome, while 24 percent of
the men and 9 percent of the women showed disturbed breathing
during sleep. (Terry Young et. al. in the New England Journal
of Medicine, April 1993). An editorial by Eliot Phillipson, MD
in the same issue of NEJM proclaimed sleep apnea as "a major
public health problem."


Effective treatment eliminates snoring and apnea. The success
of treatment is measured by the reduction of respiratory
disturbance to normal levels, by the elimination of symptoms
like fatigue and depression, and the patient's subjective
feeling of well-being. The "gold standard" treatment accepted
by physicians and others trained in sleep disorders medicine
is the continuous application of positive air pressure through
a mask during sleep (Continuous Positive Airway
Pressure--CPAP). The additional air pressure keeps the airway
from collapsing. Since this permits normal breathing to
continue during sleep, normal sleep patterns emerge, sleep
becomes restorative, and the patient feels better. The impact
is often immediate and dramatic although the patient may need
to continue therapy permanently. Weight loss, surgery and
other interventions may also have their place in treatment.
Diagnosis is made on the basis of the clinical picture,
patient and spouse reports, and an overnight polysomonogram
done in the laboratory or even at home.

The role of psychologists and psychiatrists

Even a basic understanding of sleep apnea can be the basis for
awareness and referral. A patient presenting with fatigue,
depression, or problems in social relationships might have a
primary problem of sleep apnea. If so, treatments appropriate
for depression may miss the mark. If snoring, gasps, or pauses
in breathing during sleep are reported, referral to an expert
in sleep disorders for evaluation may be appropriate.

Psychologists and psychiatrists can play an important role in
the treatment of sleep apnea. With appropriate training in
sleep disorders, they can play a part in the sleep laboratory
or in the clinic.

The patient with sleep apnea faces tremendous social and
emotional challenges in accepting therapy. A significant
number of patients fail to comply with treatment, sometimes
because they may lack appropriate emotional support and are
unable to adjust to their new status. Family members and
colleagues may not understand or accept the positive changes
in the patient's personality. And the patient and those close
to him or her must come to grips with the loss of functioning
for years before treatment. Finally, if symptoms of depression
occur in a patient with known sleep apnea, appropriate
treatment may require looking at both the treatment for sleep
apnea--is it effective?--and at the possibility of depression.
While there are support groups and patient-centered
organizations which can be very important to patients and
their families, professional intervention and support may also
be needed.

BIOSKETCH: JERRY HALBERSTADT is a publisher who suffered from
sleep apnea syndrome for more than 15 years before being
diagnosed and treated. He has served as chair for an
educational conference on sleep apnea for physicians and the
public and has co-authored a handbook for patients and
professionals: T. Scott Johnson, M.D. and Jerry Halberstadt,
1994, "Phantom of the Night: Overcome sleep apnea syndrome;"
ISBN 1-882431-00-6, New Technology Publishing, Inc.

Inquiries to:

Additional information will be available in January 1995: use
gopher to connect to and look under
ftp/books/ntp-publishers; or use ftp and login "anonymous" to, and look under ftp/books/ntp-publishers


The Evaluation Center@HSRI (TEC) is a technical assistance
center funded by the federal Substance Abuse and Mental
Health Services Administration & Center for Mental Health

The mission of the Evaluation Center@HSRI is to provide
technical assistance in the area of evaluation to States and
nonprofit public entities within the States for improving the
planning, development, and operation of adult mental health

Following is a brief description for each Topical Evaluation
Network (TEN). Although this information could have been
placed in the resources section of the InterPsych Newsletter,
we would like to inform readers that there is a sizable number
of subscribers, particularly on the evaluation and outcome
lists, that are currently running research projects, which
may lend themselves for matching up researchers with
similar interests.

1.   National Health Care Reform TEN
     The purpose of this network is to discuss how national
     health care reforms may affect mental health care and
     substance abuse systems at the state and local levels.
     The Evaluation Center will be represented on-line by
     Robert Dorwart, M.D. of the Kennedy School of Government,
     Harvard University. To subscribe to the network send e-mail
     to: containing only the following
     words in the message body: subscribe nhcten

2.   Outcomes Evaluation TEN
     The purpose of this network is to develop a broad
     collective expertise with respect to problems of
     assessing and analyzing outcomes of interventions aimed
     at improving mental health. The Evaluation Center will be
     represented on-line by Lee Sechrest, Ph.D. of the
     University of Arizona Department of Psychology. In
     addition, Gary Bond, Ph.D. of Dartmouth College will
     represent the Evaluation Center on-line to discuss
     vocational outcomes.  Bill Hargreaves, Ph.D. of the
     University of California at San Francisco, will represent
     the Center on the Outcomes Network to discuss
     implementation measurement. To subscribe to the network
     send e-mail to: containing only
     the following words in the message body: subscribe

3.   Legal & Forensic Issues in Mental Health TEN
     The purpose of this network is to facilitate assessment
     of the impacts of interventions in the broad area of
     interface between the mental health system, the criminal
     justice system, and the courts. The Evaluation Center
     will be represented on-line by Bill Fisher, Ph.D.,
     Director for Psycho-Social and Forensic Services
     Research, Department of Psychiatry, University of
     Massachusetts School of Medicine, Worcester. To subscribe
     to the network send e-mail to:
     containing only the following words in the message body:
     subscribe legalten

4.   Evaluation Methodology & Statistics TEN
     The purpose of this network is to provide assistance,
     information and contacts regarding experimental design,
     instrument and survey development and statistical
     analysis for mental health systems evaluation. The
     Evaluation Center will be represented on-line by Marcus
     Lieberman, Ph.D. of the Harvard-Smithsonian Center for
     Astrophysics, Harvard University. To subscribe to the
     network send e-mail to:
     containing only the following words in the message body:
     subscribe evalten

Further information on the lists, information on the HSRI ftp
and/or gopher site, or any technical questions, can
be obtained by contacting
[Jonathan S. Hurwitz, SK]