Tag: sleep

Reading of the Week: Drs. Maunder and Hunter’s New Book

From the Editor

We are going to teach you how to keep your head above water while you manage your complicated life, even when it feels overwhelming. Writing a book that teaches how to cope, however, feels like a monumental act of hubris. Ask our partners, friends, or kids, and they will tell you that our confidence that we can add value to your struggle, whatever it is, is not based on our having any innate coping superpowers. Rather, we know the evidence, and we have learned how to teach it.

Drs. Robert Maunder and Jonathan Hunter, psychiatrists affiliated with the University of Toronto, open their new book with this comment.

It’s a complicated world, and some people struggle. The authors try to answer a question that is both ordinary and profound: What can we do when life becomes overwhelming? Drs. Maunder and Hunter’s new book, Coping: Fix Problems, Find Meaning, Feel Better, is intended for a general audience and points a way forward, with an optimistic tone, hundreds of citations, and clear advice. The book is about coping. It’s also about trauma, adversity, and finding strength.

This week, there is only one selection: an excerpt from their new book, chosen by the authors.

How should we think about this work? At some level, it’s a really smart self-help book, offering clear suggestions on important topics. How can we sleep better? Page 87 offers tips, drawing on CBT-I. There is also discussion of box breathing (p. 102), cutting back on device time (p. 157), and more. 

The book isn’t just about living better – it’s about acknowledging that some are living through extraordinary circumstances. They open by talking about working with patients and providers during the SARS outbreak. The book includes interviews with patients. They also discuss deeper topics like CBT and DBT. At points, the book touches on philosophy; the excerpt that follows includes a discussion of Nietzsche.

The book’s central ideas are simple: fix what you can; feel better about what you can’t fix; and, when suffering persists, live meaningfully.

Thus, the book is really a break from the typical self-help books that populate the shelves of bookstores. They don’t peddle glib recommendations, such as the need to start every day by making your bed. They instead tap the literature and offer good – though not necessarily easy – advice. Coping is ultimately less a promise to make life easier than an invitation to develop a better toolkit to deal with adversity. “Coping as fully and as effectively as you can with all the adversity that is inevitable in your life will reveal who you are.”

During the pandemic, patients would often ask about maintaining mental health during social isolation – as did friends and family. Rowan Diamond and Dr. John Willan (both of Oxford University) wrote a short paper for The British Journal of Psychiatry that I often mentioned, outlining several strategies that could help. Reading Coping, I thought about those conversations – and I thought about incorporating the Maunder-Hunter suggestions into my discussions with patients now; I also thought about the patients to whom I could recommend the book. Frankly, many would benefit.

Of course, this raises a larger question: At a time when we speak more about mental health, why are we collectively doing so badly? Studies suggest that people are more anxious and depressed, feel more isolated, and rate their mental health as poorer. National data finds more homelessness, drug misuse, and workplace absenteeism. In terms of coping, then, we seem to be getting a failing grade. Drs. Maunder and Hunter touch on this topic – we live in “impossible times,” they write in the last chapter. Perhaps we will need to wait for their next book to have a better understanding of how we got here.

In the meantime, Coping is an excellent book on an important topic.

A special word of thanks to the University of Toronto Press for making this Reading possible.

Note: there will be no Readings for the next two weeks.

DG


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Reading of the Week: Bipolar & Med Adherence – the New Journal of Affective Disorders Study; Also, Sleep (QT) and Sheff on Involuntary Treatment (NYT)

From the Editor

You wrote a prescription, but did he actually take the medications? For those with bipolar disorder, pharmacotherapy is an essential part of care. Studies have noted poor adherence. 

To date, though, there hasn’t been a big cohort study. And there are good questions to ask: what drugs are more linked with adherence? Who is more likely not to take the medications? In a new paper just published in the Journal of Affective Disorders, Dr. Jonne Lintunen (of the University of Eastern Finland) and his co-authors attempt to answer these questions. They draw on Finnish data, covering more than three decades and including over 33 000 patients. “The majority of patients with bipolar disorder do not use their medications as prescribed.” We consider the paper and its clinical implications.

In the second selection, Dr. Michael Mak (of the University of Toronto) comments on sleep in a new Quick Takes podcast interview. In this sleep “update,” we talk about meds, CBT, and the mobile apps that he recommends to patients and their families. We also explore the history of sleep medicine and mull the growing role apps and wearables are playing in both diagnosis and therapy. “The lines between sleep, health, and mental health in general are blurred.”

In the third selection, author David Sheff talks about his son’s addiction and recovery – and involuntary treatment. In a New York Times’ essay, he notes the challenges of engaging those with substance problems. He sees several ways forward, including involuntary treatment. “Many people in the traditional recovery world believe that we must wait for people who are addicted to hit bottom, with the hope that they’ll choose to enter treatment. It’s an archaic and dangerous theory.”

DG

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Reading of the Week: Better Sleep, Less Psychosis? The Freeman et al. Study on Sleep & CBT

From the Editor

If students sleep better, are they less likely to have mental health problems like paranoia?

In this week’s Reading, we look at a new study from The Lancet Psychiatry. In this single-blind, randomized controlled trial, Oxford professor Daniel Freeman et al. consider students from 26 universities with insomnia, assigning them CBT (offered over the internet) or the usual care.

Spoiler alert: the students with CBT did better.

Sleep: good for babies, teddy bears, and students

In this Reading, we review that paper and consider the broader implications.

DG

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Reading of the Week: Insomnia and Its Treatment

Cognitive behavioral therapy for insomnia (CBT-I) is a multicomponent treatment package that usually includes stimulus control, sleep restriction, and cognitive therapy and has emerged as the most prominent nonpharmacologic treatment for chronic insomnia. Previous meta-analyses have found that CBT-I improves sleep parameters and sleep quality at post treatment and follow-up for adults and older adults. Most of these studies selected individuals with primary insomnia, excluding patients with co-morbid psychiatric and medical conditions. However, patients with insomnia who present to internists and primary care physicians are likely to report comorbid conditions associated with the sleep disturbance. Furthermore, insomnia was previously conceptualized as a symptom arising from the comorbid disorder and treatment was targeted at the underlying disorder. However, accumulating evidence indicates that insomnia can have a distinct and independent trajectory from the comorbid disorder, thus indicating a need for separate treatment from the comorbid condition.

So begins this week’s Reading, which considers CBT-I for people with insomnia. Here’s a quick summary: big study, big journal – and big relevance to your patients.

This week’s Reading: “Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis” by Jade Q. Wu et al. was just published in JAMA Internal Medicine. Find the paper here.

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Wu et al. consider a very common problem: insomnia. Many patients – whether they have mental health issues or physical health issues – struggle with insomnia. Boston University health economist Austin Frakt has written about his insomnia for The New York Times. He notes that he decided to receive treatment when:

One weekend afternoon a couple of years ago, while turning a page of the book I was reading to my daughters, I fell asleep. Continue reading