.

Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.

Good evening.

I'm psychiatrist Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind.

Now.

This 26 year matters the Mind is a live call in program where you have the chance to choose the topic for discussion.

>> So if you have any questions concerning mental health issues, give me a call here in the Fort Wayne area by dialing (969) 27 two zero or if you're calling a place long distance coast to coast you may have you made toll free at 866- (969) 27 two zero.

Now on a fairly regular basis we're broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lie the shadows of the Purdue Fort in campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me via the Internet at matters of the mind all one word at WSW Edgard that's matters of the mind at Organo Start tonight's program with a question I recently received it reads Deardon Evolver I have insomnia.

>> What can be done to help fall asleep?

I've tried several medication prescription medication.

What's the next thing to try?

Well you mentioned trouble falling asleep.

We call that initial insomnia.

>> Initial insomnia is where you have trouble going to sleep and there's one medication that's over the counter.

>> It can be used for initial insomnia and is called melatonin.

A lot of people have tried melatonin.

Many people tried it to a high of a dosage.

>> So melatonin is fine and a half milligram up to three milligrams bedtime.

Many of the over-the-counter formulations are five and six milligrams but a small amount of melatonin basically within about 30 minutes tells your brain to go to sleep.

>> But it's like a puff of smoke, melatonin is there very briefly we all have melatonin being secreted naturally from our pineal gland .

Pineal gland is right here in the middle of the brain and at nighttime as it gets dark, melatonin gradually rises and it tells your brain to go to sleep so darkness will help increase melatonin.

>> So in terms of helping yourself get to sleep, some of the things you want to do if you're having trouble falling asleep is number one try to get in the routine of going to bed the same time every night and even though you might not be ready to get up in the morning, try to get up at the same time every morning if you sleep in in the morning it basically throws off your circadian rhythms such that you have what we call delayed sleep cycle and you go to bed later and you get up later.

Adolescents prefer to do that.

That's how their brains are working adolescents prefer to go to bed at 11:00 pm or midnight and then they want to get up later in the morning.

That's how their brains are working.

Their brains are still growing.

But for the rest of us as adults, yeah, we need to get up at a certain time every day to go to work or attend to our responsibilities and in doing so you have to get to bed at the same time every erratic times in getting to bed will often cause you to have a horrific sleep hygiene in general.

>> Second thing you want to do is try to create some of that darkness as you're going to bed.

So try to get off your computer screen, try to get off your cell phone and certainly shut down the television within at least an hour of going to bed.

It's really difficult for a lot of people to do because we're so used to looking our cell phones or even looking at the computer screen.

>> But if you're doing any work related activity late at night the brightness of the screen will keep you awake.

>> Also the stimulation if you're doing work related activity, the stimulation will keep you up to.

However, if you're reading something reading from a book the brightness of the light shining off the book won't be as stimulating to the brain.

>> And if you're reading something that has one chapter after another after another so you can actually put it down at a certain point that's going to be able to help you get to sleep a little bit earlier to exercising is fantastic in the morning but if you're prone to having difficulty getting to sleep, try not to exercise after about six p.m.

I'm always vacillating whether I should advise people to not exercise in the evening or not because exercising in general is great for not only your physical health but also your mental health .

>> But if you're having trouble sleeping you'll have trouble exercising in the you'll have to if you're going to have trouble with exercising in the evenings so you want to exercise earlier in the day if you're having trouble sleeping at night.

>> Many people have been aware that caffeine intake after about five p.m. a night for some people to keep them awake now caffeine often wears out of the system after two or three hours but some people are very sensitive to the caffeine intake after about five or six p.m.

So you need to be careful about that eating any spicy foods or eating a full meal later in the evening after about seven or eight p.m. can often give you difficulty getting to sleep.

Some people will say that eating a small snack will help them get to sleep.

But for many people eating prior to going to bed will keep them away because their stomach is still digesting the food.

They can have a little bit of reflux and that can be a factor.

I will often look for underlying issues concerning difficulty getting to sleep because some people for instance might have a condition known as sleep apnea where they have trouble with snoring or breathing when they're laying on their backs and they'll notice that as they're starting to fall sleep they'll gasp and that gasping will actually awaken them.

So that can actually be a cause for having difficulty getting to sleep.

So I'll often advise people to be assessed for sleep apnea.

They're having any trouble with snoring or if they've been witnessed in pausing in their breathing at night.

That's a very common condition.

It's extremely treatable and people sleep apnea will not only have trouble getting to sleep but they'll also have trouble with focus and concentration during the day they'll be tired and many times people will be kind of grumpy so if you're having trouble with getting to sleep, a lot of different issues out there.

>> Some of the traditional medications used for sleep such as Ambien, Lunesta these are medications that basically will work on the reticular reticular activating system which is in the brainstem here and basically that will go right there and shut down the brain, help you get to sleep and that's fine.

But sometimes you can get used to some of those medications so you might not want to go that direction long term if you're having trouble getting to sleep.

>> The first thing to do is try to work on the sleep hygiene to get into some kind of routine night by night by night and train your brain that at a certain time that's the time to go to bed and training your brain means trying to get to bed the same time even if you can't get to sleep, try to turn the lights out good about the same time every night but most importantly get up at the same time every morning if you need to nap during the day which you often will if you're having trouble sleeping it's a night and not being able to sleep at night if you're tired or in the day you can take a nap and a nap is wonderful for the brain if you don't nap for more than twenty or thirty minutes, if you're not for more than twenty or thirty minutes you'll likely have trouble getting sleep at night because your brain has already gotten the message that you've had enough sleep during the day.

So a power nap during the day.

I'm often telling this to medical students who I teach a power nap actually Firas go up the thinking part of your brain if you have a power nap for twenty or thirty minutes it basically will help the front part of your brain get reenergized and get kind of clear it out and you'll be able to think and be able to focus on things much more clearly thereafter.

But more than about a 30 minute power nap well often interfere with your sleep at night.

>> Thanks for your question.

Let's go to our first caller.

Hello Wilson and welcome to Matters of Mind and Wilson, you want to know if health conditions in general can cause mental health disorders and can one mental health disorder trigger another mental condition?

Health conditions can cause psychiatric look alikes.

I mentioned already sleep apnea for instance, sleep apnea as a condition where your snoring you're not getting enough air flow to the lungs thereby not getting enough oxygen to the brain that will cause you to feel tired, depressed.

You'll have trouble with feeling kind of irritable and edgy during the day people sleep apnea will often have mental health problems not& uncommonly secondly, a condition that is very common for young women called postural orthostatic tachycardia syndrome also known as pottz.

>> It's a condition where your heart rate starts going really fast just out of the blue and you get lightheaded and you can pass out with that perception of the increased heart rate.

For one thing you can have a weakness in your arms and legs and that will cause people to think well gee, you're just faking it.

>> You don't want to get up and you're just lazy .

And also the fast heart rate can give you a sense of having a panic attack.

So it's a sight it's a it's a medical condition.

It's a real condition that needs to be addressed medically with a cardiologist.

But it can give you a lot of psychiatric kind of conditions.

Another medical condition that psychiatric conditions will be migraine headaches.

We see that more commonly with women than men but people with& migraine headaches often will hand in hand have bipolar disorder where people will have manic highs and big depressive lows and you wonder chicken or the egg is at the manic condition depressive condition contributing to the migraines as the migraines can drifting is probably going back and forth but they are associated in a lot of different ways.

Many people with asthma for instance, will have trouble with panic attacks because you can imagine if you are having an asthmatic attack you'll feel really anxious right out of the blue and that will cause you problems with anxiety and that worsens the breathing condition itself.

Now can one mental health condition affect another mental health condition and example that would be somebody attention deficit hyperactivity disorder ADHD.

People with ADHD will often have another medical condition called binge eating disorder.

>> People with ADHD are prone to binge eating where they eat unnecessarily and they will eat excessively even though they don't need to do so.

People with post-traumatic stress disorder will often have other conditions such as insomnia and they'll have various other anxiety conditions that lead to depressive conditions.

So we often hear about this cascade of anxiety leading to insomnia which leads to ongoing depression day by day.

>> So it's something in which we have to take all those conditions in effect.

Wilson we have to take the condition in consideration the medical conditions and how they are affecting the mental health conditions and how these mental health conditions can all play a role in making the other conditions worse.

So we do take all those considerations in mind.

Wilson, thanks.

Your call.

Let's go next caller.

>> Hello, Keith.

Welcome to Matters of Mind.

Keith, your comment you mentioned that you were prescribed risperidone that's also known as Risperdal but it makes you lose your balance so you stopped it.

Well, stopping the medication caused more damage than the side effect itself depends in which for what condition you're being treated.

>> Keith Risperidone is used for many different conditions.

It was originally used back in the late 1990s for schizophrenia and then it was readily found to be effective for bipolar disorder and then over the course of time we've used it in an off label manner and matters in which it was not formally FDA approved for conditions like depression and post-traumatic stress and other anxiety conditions like obsessive compulsive disorder.

So risperidone can give you a lightheadedness and thereby dizziness by blocking this particular receptor in the brain called Alpha One receptors.

If you block alpha one receptors you get lightheaded and you can kind of have difficulty with dizzines and kind of feel woozy.

>> The good news is there are many other medications out there, Keith, that do treat the same conditions by which risperidone will treat.

>> So there's a lot of other options out there that might not affect you as much as the risperidone.

>> So stopping risperidone itself wouldn't be so problematic for you.

It's just that is the underlying condition condition in which risperidone was being used is that being addressed?

>> That would be the main issue there.

Keith, Keith, thanks for your call.

Let's go to our next caller.

Hello Heather.

Welcome to Matters of Mind.

Heather, you mentioned that you'd like to know if bipolar disorder can cause weight gain and diabetes itself.

Heather, that's an interesting question because one hundred years ago there was a psychiatrist by the name who had the name of Llorens and Dr. Lawrence was up there in Madison, Wisconsin and he examined people in the state hospital who had what we now call bipolar disorder.

He called them manic depressive disorder back them and he noticed that these people with manic depressive disorder had a higher likelihood of having higher glucose as compared to the rest of population in the 1920s.

>> Other Type two diabetes where you had adult onset diabetes where you started getting more and more insulin resistant over the course of the years in the 1920s that was almost unheard of to have adult onset diabetes.

People knew about type one diabetes were early on in your life you'd have the pancreas not secreting enough insulin but type two diabetes is a condition where the the you're you're secreting excessive insulin and it's not able to keep up with the receptor needs of the periphery of the body.

So your insulin goes higher and higher and higher with type two diabetes and that leads to higher blood sugars and eventually you have trouble ith weakness in alle diabetic complications.

So manic depressive disorder and type two diabetes will go hand in hand.

Now what happens some of these newer medications that came out of the past 25, 30 years, they might have had an effect on the serotonin receptor in such a way that it can affect the insulin sensitivity at the receptor level.

That's more debatable whether it really did or not.

A lot of the newer bipolar medications have an antihistamine effect as an antihistamine that can increase your appetite, that can increase your weight.

>> So if your weight increases that's a risk factor for type two diabetes.

>> But it's not the only risk factor for Type two diabetes.

The risk factors for Type two diabetes will be gaining weight.

That's one of them.

But also getting older will increase your risk having a mental illness such as bipolar disorder or schizohrenia drastically will increase your risk of Type two diabetes because you're under a lot of stress if you're not sleeping or if you're moody you're having trouble the irritability that's going to increase your cortisol production cortisol a stress hormone that will indirectly increase blood sugars and in doing so cause you need to secrete more insulin overall.

So when we talk about bipolar disorder, yeah, we do monitor for type two diabetes but simply changing a person from a medication that might have contributed some weight ain to another medication that does not contribute so much to weight gain will not resolve the issue concerning the risk factors for diabetes you still have to monitor for diabetes especially if you're not doing so well because interestingly penough the people with bipolar disorder who aren't doing well or even at a higher risk for developing diabetes because they're under so much stress.

>> So if you're taking medication that's not giving you weight gain, great.

>> But as the medication working for bipolar disorder, if it's giving you mood stabilization, that's fantastic.

>> But if it's not helping you, that's going to be more likely to give you higher risk for diabetes even though you might not be gaining any weight.

So it's something where we have to balance out the pros and cons of mood stabilization versus weight gain and look at all that in conjunction with risk factors for Type two diabetes.

>> Heather, thanks for your call.

Let's go to our next our next email we've got another email here.

>> Another email says Dear to father, why do dreams appear to be so vivid and lifelike when we are really asleep?

>> Dreams are originating from your hippocampus over here on the temporal lobe of the brain.

your memories and all your past thoughts.

That's your library of the brain.

>> When you're dreaming you shut down the thinking part of the brain right up here in the front part of the brain.

The left front part of your brain is the brain that you use to pay attention to things to focus, to concentrate that part of the brain shuts down entirely when you are dreaming and when you're dreaming when that's shutting down what's happening is you're getting you're getting an effect where indirectly it's allowing your your hippocampus just to run wild and have very crazy thoughts without the inhibition that you would have during the day.

So during the day you might not think certain thoughts until that thinking part of the brain the judgment part of the brain is just shutting down entirely now and that shuts down entirely.

What's happening is the neural norepinephrine transmission is decreasing significantly.

So when norepinephrine transmission up in the front part of the brain shuts down that allows you to dream but it also makes your dreams very abstract.

Don't make a lot of sense.

So when they don't make a lot of sense your brain will act like a whiteboard first thing in the morning upon getting up in the morning you'll forget all your dreams within a matter of minutes unless you write them down.

So people who are trying to do some back door psychoanalysis with for themselves will often write down their dreams on their cell phone or on their pace piece of paper and just write them down immediately upon the getting up to try to remember them because within a matter of minutes your brain just erases all recollection of your dreams and that's because you're waking up the logical part of your brain is firing back up as that logical part the brain starts to fire back up.

>> You're going trace all your dreams for that night.

So with dreaming it's something that can be very vivid because it is your thoughts and usually it's abstract.

>> It's it's symbolic thoughts that of things that have happened to you in the past 24 to 48 hours.

>> So as you dream throughout the night you're kind of reviewing some of the things that have happened over the past 24, 48 hours.

>> But the brain has the remarkable ability to make everything symbolic so it's not highly apparent to you and over with somebody else or even think through it during the day you always want to try to relate.

OK, how does this symbolically relate to what might have happened to me over the past day or two ?

So when you're dreaming all that symbolism is coming out.

>> Your first dreams usually occurred about an hour and a half into your sleep as you go through the night you tend to have more intense dreams and more vivid dreams such that the most vivid and most intense dreams you're going to typically have will be just upon the early morning hours right.

Right before you awaken now while you're dreaming, remember that what you're dreaming you're not going to act out your dreams normally what you're dreaming your body should be paralyzed is called sleep paralysis.

If somebody awakens while they're dreaming, it kind of freaks them out.

But when they awaken while they're dreaming, they will have difficulty with being able to move naturally.

Your body should go into a state of sleep paralysis where you're not moving at nighttime and that way you're not acting out on your dreams.

>> Thanks for your call.

Let's go to our next caller.

Hello Jim.

>> Welcome to Matters of Mind.

Jim, you want to know why do your medications levothyroxine and atorvastatin also known as Lipitor make you sleepy?

I'm not sure why they would make you sleepy.

>> Usually Jim Levothyroxine, which is a thyroid hormone also known as for will give you more of an activating and energizing effect if you're low on T for maybe it's not adequately dosed for you just yet but if you're low on T for you don't have enough thyroid.

Thyroid comes from the little gland on your neck if you're low on T for low on thyroid it will make you tired.

You'll be foggy, you'll have trouble with concentration but even those blurred vision might have constipation if you're thyroids too low if you're so if you're thyroids too low that could make you sleepy.

>> Atorvastatin also known as Lipitor does not usually make a person sleepy but if you think about it it is suppressing the manufacturing of fat in the brain as well as the rest of the body which decreases your risk for cardiovascular disease presumably.

But in decreasing your risk for cardiovascular disease by decreasing the fat deposition on the blood vessels throughout the body possibly for some people not real commonly but for some people it can decrease the fat deposition in the brain in such a way that it decreases the myelin sheath production myelin sheets are is the natural insulation around the individual neurons that allow your nerve cells to communicate with each other more effectively.

And if you start atorvastatin or any so-called lipid lowering agent all of a sudden you know you're sleepy and I often hear more difficulty with cognitive impairment.

They're not just tired but they can't think very clearly.

>> And if you can take it back to that lipid lowering agent OK, sometimes that'll be a factor in itself and that's one reason why people have to go off of lipid lowering agents.

But we always wanted to be to coordinate those decisions with a cardiologist to make sure you're going to be heart healthy and have good choices there.

>> Jim, thanks for your call.

Let's go our next caller.

Hello Kristen.

Welcome to Matters of Mind.

Kristen, you want to know if your natural reaction to fear is fight or flight?

Why do people some people freeze up?

>> Freezing is actually a type of condition where you're your ability to fight or flight or fight or flight is just overwhelmed.

That's a reason why some people will need medication when they get in panic situations because they'll just shut down.

And what'll happen when you freeze up is because this called the amygdala run the tip of the temporal lobe here that's getting really fired up and OK, you're supposed to either run that's the fight part of it or or fight and actually address the problem directly if you freeze up it's a mean of of it's a means by which your body is getting shut down physically and mentally and you can't think very clearly.

So if the amygdala is overwhelmed and it's firing out messages to the rest of your brain, you're not going to be able to address the situation appropriately.

So that's where people get in trouble because if their amygdala hijacks their thinking part of the brain they can't decide whether to run for the situation or fight it out so they freeze and they do nothing .

And that's because basically the front part of the brain, the thinking part of the brain has been hijacked and it's just not going to work.

So you are always trying to get the front part of the brain and the amygdala to work in tandem if you're under a stressful situation, let's say you're doing something as simple as driving on the interstate in a heavy traffic you're having to weave in between traffic.

Your amygdala should be a little bit more fired up during that time to make you more alert.

It's not that you're fighting.

It's that you're more alert during that time.

So the amygdala should fire up the thinking part of the brain in situations where you're under a lot of stress.

But if the amygdala overwhelms and floods the front part of the brain with neuro transmission and front part of the brain can't think you'll end up kind of freezing up and not doing much.

So that's where people get into trouble with their front part of the brain not working when they become overwhelmed.

Thanks for your call.

>> Let's go our next caller.

Hello Rose.

Welcome to Matters of Mind.

>> Rose, you want to know is lithium still used by any doctor is actually lithium?

It's been around since nineteen forty nine I believe it's it was it was studied and discovered in Australia.

It's cames all the dirt and it was reused prior to nineteen forty nine in soft drinks the old form of Seven-Up had lithium in it and people would use lithium back in the soft drinks in the early 20th century I think it was and they feel calmer and they felt pretty good.

They felt kind of chilled out and then a lot of people got lithium toxic because they just drank too many of those soft drinks and they took it off the market.

So in nineteen forty nine wasn't the lithium was discovered it was discovered to be an effective treatment for a bipolar disorder also known as manic depressive disorder.

So lithium is in the same category as sodium on the periodic table and if you look at that particular column with sodium lithium they work in a similar way.

But lithium is a remarkable medication in giving mood stabilization for people who have manic episodes.

So if you have skyhigh mania where you don't need to sleep, you have impulsivity, your thoughts are racing, you're doing things you ordinarily wouldn't do or say.

Lithium can be a great medication in most cases because lithium specifically more so than a lot of the medications will give the brain and antiinflammatory effect in giving the brain an antiinflammatory effect.

It can settle down mania because it's thought that when people get manic episodes their brain is literally inflamed so lithium can settle down the inflammatory effect that's occurring during a manic episode.

>> Lithium is also very commonly used at tiny doses rose for people who have suicidal thoughts.

>> I've seen this as a clinician myself over the years when I give somebody a tiny, tiny tiny dosage of lithium just 150 milligrams at bedtime accommodates just 900 milligrams a day.

>> But 150 milligrams of lithium at that time can dramatically decrease a person's ruminative suicidal thinking.

Some people will start thinking about suicide.

They're thinking about death.

They have no other way to get out of their life circumstances .

>> You give them a little bit of lithium with their antidepressant medication and often it can have dramatic impacts and a low dose you lithium should not give them any side effects or toxicity.

We still will check blood tests when not even on a low amount of lithium but a small amount of lithium presumably due to its ability to have that antiinflammatory effect can decrease suicidal thinking for so many people.

>> So Rose Lithium is still used by clinicians.

>> It's preferable to use the controlled release long acting version and use it only at nighttime for two reasons.

If you use the controlled release version it's easier to use because it's only once a day dosing if you use it only at bedtime you're less prone to getting liver are less prone to getting kidney problems.

So we try to avoid kidney problems by having people just take the one dosage at nighttime right before they go to that helps them sleep.

Lithium actually improves the sleep architecture overall and gives people a better night's sleep overall.

Rose, thanks for your call.

Unfortunately I'm out of time for this evening.

If you have any questions concerning mental health issues you may write via the Internet at matters of the mind that dug.

>> I'll see if I can answer that on the air.

God willing a PBS willing.

>> I'll be back again next week.

Thanks for watching Matters of Mind on PBS Fort Wayne now on YouTube.

>> I'm psychiatrist Jeff Olver and you've been watching matters of mine.

Have a good evening.

Good night Cameron Psychiatry.

Providing counseling and care for those that may struggle with emotional and behavioral challenges.

More information available at CameronMCH.com.