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Gabrielle J. Melin, M.D.
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Gabrielle J. Melin, M.D.
Gabrielle J. Melin, M.D.
Dr. Gabrielle Melin, board certified in general psychiatry and psychosomatic medicine, is looking for ways to empower patients and families dealing with chronic mental illness. She encourages patients to commit to working together with their physicians and health care teams.
Dr. Melin completed medical school at the University of Minnesota. She completed both her psychiatry residency and consultation-liaison fellowship at Mayo Clinic before joining the Mayo Clinic staff in 2001. She is medical director of Mayo Clinic Psychiatry Emergency Services in Rochester, Minn. She has special interests in emergency psychiatry, adult psychiatry and addiction psychiatry.
"Instilling hope is one of the most important things we can do for patients and families. Mental illness can be chronic and significantly impacts lives. Our goal is to provide the best treatment and education so that patients can manage their symptoms more effectively," she said.
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Depression blog
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May 22, 2008
Quality sleep helps treatment
By Gabrielle J. Melin, M.D.
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Sleep is important, but the quality and amount of sleep are even more important. We know that our sleep directly impacts our health.
You may sleep soundly and go through the various phases of sleep normally. Alternatively, you may snore, act out your dreams, sleepwalk, move your arms and limbs, or even have sleep apnea, a condition in which one temporarily stops breathing because the airway is blocked. If you are not consistently getting a quality night's sleep, then your depression cannot be fully treated.
Sleep is the time when our brain and body "recharge" for the next day. This affects our mood, energy level, concentration and overall functioning. Even if you sleep for say six hours every night and it is quality sleep, is that really an adequate amount? Some people do great on six hours long-term, while others may need more. Under periods of stress, you may require more than you normally do.
There are many symptoms that may indicate a sleep disorder. The causes of sleep disorders vary, so discussing with and being evaluated by a qualified provider is important. Some symptoms may include excessive daytime sleepiness. This is different from fatigue or being tired. This can be a symptom of sleep apnea. Other accompanying symptoms may include frequently awakening with morning headaches, sore throat, dry mouth (from mouth breathing), waking up with a choking sensation or not feeling refreshed upon awakening.
One of these symptoms alone does not diagnose sleep apnea. The physician needs to evaluate you as a whole person. Do you have a crowded airway? For instance, is your tongue or uvula large, do you have trouble breathing through your nose, are your tonsils large? Obesity is a risk factor, but not all overweight people have sleep apnea and thin people can get sleep apnea too. This sleep disorder can occur in men and women. Treatment varies as well, depending on the cause. Sometimes people need a breathing machine, called a CPAP. Some people may need their tonsils and adenoids removed.
Some medications and alcohol will cause the muscles in the throat to relax too much which can lead to snoring (like a flag flapping in the wind). Snoring can be disruptive and does not always lead to apnea or cessation of breathing. People can have mini arousals during the night that they do not remember. This can be frustrating as the person may "think" they're sleeping well, when in fact they're not. Increasing one's antidepressant medication will not treat sleep apnea. Bottom line is that poor quality sleep over time can cause and/or worsen one's depression.
12 comments posted
April 27, 2009 6:18 p.m.
I go through cycles of no sleep. The last for a couple months. I dose my own medications which is an awful idea. I finally crash and tell by psyc what is going on. This time I got so bad that I ended up in a psych ward for 5 days. My husband has stated that I've recently started snoring. I'm wondering if I have sleep apnea. I'm currently diagnosed with Bipolar. I take enough meds to knok out an elephant
- Crissy
April 22, 2009 11:21 a.m.
I developed a severe major depressive episode in 1997 and with that, I experienced severe sleep problems. Problems with severe insomnia, extremely restless sleep, completely nonrestorative sleep, constantly waking up repeatedly, etc. The psychiatrists I used just prescribed psychiatric meds...nobody even suggested I have a sleep study and get screened for sleep apnea. I suffered severely for ten years with "treatment resistant depression," being rotated from one psychiatry drug to another, to no avail. Finally, in 2007, a pulmonary specialist sent me to a sleep study, diagnosed me with obstructive sleep apnea and I was put on CPAP, with good results. Finally, the restless sleep is gone, my sleep is much more restorative, my insomnia improved dramatically and my mood and cognition improved. It also helped restore my ability to exercise hard. Im somewhat angry at psychiatry for stringing me along for ten years and never taking the bull by the horns and not referring me for a sleep study. Its obvious to me...as well as my family...that sleep apnea is at least half my problem. Psychiatry needs to get with it...they have a poor reputation and a bad name and its reasons like this that many dont care for the specialty. All they are is pill pushers and most Pdocs dont look aggressively for underlying medical conditions that could be causing mood/anxiety problems or psychosis. I still take an SSRI, but without CPAP compliance, it hardly works.
- Reggie
March 25, 2009 11:55 p.m.
If you are experiencing poor sleep on an ongoing basis it WILL lead to other problems like depression, ED etc. In my case the culprit was sleep APNEA (severe while in REM sleep). The classic symptoms were there, included waking up at night holding my breath feeling like I was choking, morning headaches, low energy, always tired etc.. A diagnosis by the sleep lab led to CPAP therapy. I am gradually getting my life back now that I can sleep well. Good sleep IS neccesary as it allows one to have the energy to cope effectively with the daily stresses of life.
- Alan
October 8, 2008 8:42 p.m.
Hi there I'm not sure if you know more about what I have the Doctor I spoke to here called it "nocturnal anxiety". I have five times the amount of arousals per hour a night then the average person. And I am looking for more information about these "arousals" that spike me into wakefulness for a split second. I don't want to take addictive sleeping pills or paxil as was suggested because the side affects are scary. But I need to start sleeping right because its starting to affect my life and ever aspect of it... health , relationships, job, concentration, physical strength and of course sleep. The doctor I spoke with said I was born this way... and I have had issues since I was a child, but I would really like to figure this out more...learn about it so I can stop it from happening. Can you send me information about "arousals" during sleep cycles. Thank you, Stef
- Stef
July 13, 2008 9:03 a.m.
My husband was diagnosed with extremely severe sleep apnea approximately 3 year ago. At the same time he went into a major depression episode lasting for a year. He uses a C-Pap. Now he has gone into another depression and to date the medications have not helped. I know he doesn't sleep "normal" even with the C-Pap and he stays in bed almost 24/7. What can I do to help him? At this point I am fighting going into a depression along with him. I am emotionally, mentally, and physically exhausted. I also am in pain 24/7 from back problems which I can not get treatment for due to lack of insurance. I have a hard time staying patient and understanding with him due to my physical pain and feel that I am letting him down. Thank you for allowing me in your blog.
- Sandy H.
May 29, 2008 7:48 p.m.
I am happy to see such a pertinent but yet simplified version of issues concerning sleep apnea. If I did not already have knowledge and experience with both depression and sleep apnea, I would certainly understand them both better after reading this article. Thanks so much. Penny
- penny foss
May 28, 2008 11:08 a.m.
My condition began with extreme pain, then hormone changes & allows me to fall asleep without difficulty, but I wake up after 3-4 hours of sleep. If the sleep was uninterrupted, then I feel somewhat refreshed, but not as much as on weekends when I can roll over & go back to sleep for another hour or so. I do not take RX sleep meds, but I do take hormones, as without them, I was getting 1-3 hrs per night: and all of my life I averaged 6 hrs of sleep per night. I stay away from many meds as I have hyper reactions to most & end of feeling spacey, having vertigo type symptoms & the effects take at least 72 hrs to leave my system. I sincerely would like to get back to 6 hrs/night.
- Barbara
May 28, 2008 12:46 a.m.
I've got bipolar disorder type II, and I've been on all the meds. Remember that meds adjestment is a constant process. What works for one person may not work for another. There are lots of possibilities--find a really good psychiatrist and engage in a constant dialogue. Unfortunately mood disorders are hugely difficult, but not impossible, to battle. A second opinion is always a good idea too. Some of the disorders are very hard to diagnore. BPII is 70 percent misdiagnosed originally. This has big consequences, since the meds for major depression are ineffecctive against bipolar depression. You may also get a lot of useful information from peers at a support group. I go to a DBSA--Depression and Bipolar Support Alliance, and it is very helful. I was skeptical: I've been sick over 30 years-what could I learn? Coincidentally, our topic last week was sleep (also diet),precisely the issues being discussed here. Lots of good advice to be had. As for the vivid dreams, one of the atypical antipsychotics did that to me. I didn't like it either. The meds I'm on now result in zero dream recall. Talk to your doctor. A lot of the comments, for example still being tired after lots of sleep,are reflective of standard characteristics of clinical depression. Again, talk to your doctor or educate yourself by getting more info on some of the really good sites==DBSA, NIMH (National Institutes of Mental Health), Nami. What you are going through is normal.
- taras mom
May 27, 2008 3:48 p.m.
Normal People Either Sleep Or They Don't Benydral is all they have to offer, If you take any presciption Medication That's That's a Mistake, All the Drug Companies want to do is get you addicted to it.
- Ed
May 23, 2008 5:57 p.m.
I've always been in the category of "depression plus hypersomnia". I sleep 8 hours or more every night and still don't feel refreshed. I, too, get the "thinking conversations" sometimes but rarely have trouble falling asleep more than 20 minutes after going to bed. Something that helps me is meditation/guided imagry CDs. There are some good ones out there that help put you "in the moment" instead of thinking about what happened that day, or will the next day... A recent problem for me has been nightmares and vivid dreams that wake me up every couple hours. Anyone else been through this?
- Erin
May 22, 2008 11:34 p.m.
I have some of the same issues....I end up just "sitting up" watching tv until 4, but its usually due to the endless mindless "self-talk" that goes on in my brain 24-7. No, I dont hear things, but its like a continuous "thinking conversation" with myself. Depacote seems to quiet this down, its something new for me to take. My prescriber started me on it to get my sleep habits down to normal. Im reall kinda new to the "asking for help" thing too, so this site here came along so I signed on....
- skydiver57
May 22, 2008 4:17 p.m.
Sleep is usually the first indicator that my depression is taking a turn for the worse. I never sleep well or wake up refreshed, but when it takes hours to fall asleep and then I wake up every 30-40 min, I know I'm in trouble. As of late, I give up by ~3:30 4 a.m. and am up for the unending day. I am miserable and cannot function to any degree with this quality of sleep and depression. I have been evaluated by several sleep specialists and it all comes back to it's just the depression and take a pill and live with it. The trouble is all the sleep meds don't help me sleep but make me even groggier during the day. I don't understand how I can be so sleepy and exhausted all day long, but yet can get no quality sleep at night.
- elmur
12 comments posted