Sleep Physician; Sydney Sleep Centre; Senior Staff Specialist, Prince of Wales Public Hospital
Dr Anup Desai is a Specialist Sleep Physician with many years of broad clinical experience across a range of sleep disorders, from snoring and obstructive sleep apnoea, to insomnia, parasomnias, narcolepsy and other non respiratory sleep disorders. He is a Senior Staff Specialist at Prince of Wales Public Hospital in Randwick. He has a PhD in Sleep Medicine through the University of Sydney. He is a Medical Assessor for Respiratory and Sleep Disorders at The NSW Motor Accidents Authority and serves on their Review Panels. This complements his extensive medicolegal work, predominantly in assessing Sleep Disorders in the context of driving and fall asleep road accidents. Dr Desai maintains an active clinical private practice, reviewing patients at Sydney Sleep Centre in the city and in Randwick consulting rooms.
The role of the sleep psychologist, Insomnia - learn how to take a detailed history and how this can lead us toward a nuanced diagnosis, and therefore a more appropriate management plan. Additionally, how CBT is the first line treatment for insomnia, and it is far more than sleep hygiene
How to interpret a sleep study more effectively, why you should not skip the sleep physician's conclusions, and how to understand the graphs and hypnograms
Become familiar with breathing disorders that are not obstructive sleep apnoea and non-respiratory sleep disorders. Learn how to take a sleep history and how to structure our approach to the sleepy patient
Sleepiness is a complex issue and we need to explore the clinical context and other possibilities before arriving at the decision to perform a sleep study
Insomnia is a common condition in which patients experience difficulty initiating sleep, maintaining sleep and/or wake earlier than desired. It can cause significant distress and impaired functioning.
Population surveys suggest that approximately 33% of the population experience at least one insomnia symptom, with only 1 in 10 seeking treatment. Female gender, older age, pain and psychological distress have all been associated with increased prevalence rates.
There is a strong association between insomnia and psychiatric disorders, such as depression, anxiety, and drug abuse. Rates of psychiatric comorbidity as high as 80% have been reported, with insomnia predating the onset of mood disorder in approximately half of cases. Insomnia has also been independently associated with increased healthcare utilisation, increased workplace injuries and absenteeism, and reductions in quality of life. A number of studies have demonstrated an association between insomnia and increased cardiovascular risk.
The management of insomnia can broadly be categorised into pharmacological and non -pharmacological therapies. Although pharmacotherapy is often used first by doctors and as primary therapy, it is not indicated long term and should not be used in isolation. Pharmacotherapy is only indicated for short term use. Benzodiazepines, non-benzodiazepine hypnotics, melatonin, sedating anti-depressants and antipsychotics have all been used. The majority of these agents have been shown to be more efficacious than placebo in short term randomised controlled trials, however their use is often tempered by extensive side effect profiles, detrimental effects on sleep architecture and the risk of tolerance and dependence.
Non-drug treatments for insomnia, namely Cognitive Behavioural Therapy (CBT) for sleep are very effective both acutely and for the longer term. CBT for sleep should be initiated in all patients. CBT is effective as a sole treatment for insomnia or it may reduce the reliance on medications in the longer term. CBT addresses dysfunctional behaviours and beliefs about sleep and consists of sleep hygiene, stimulus control, sleep restriction, and cognitive restructuring.
In the past, access to CBT for sleep has been a challenge, with limited trained providers and poor availability. However, recent studies of computer based (online) CBT for sleep have been encouraging with comparable efficacy to conventional CBT for sleep. Online CBT can be accessed in Australia through the US based SHUTi program if referred by GP’s or Specialists (http://www.sleepcentres.com.au/online-insomnia-cbt-program.html). Online CBT for sleep is convenient, effective and easy to access, and arguably is a good option for non-drug insomnia management for all patients.
This article discusses the evidence for and role of aspirin in the secondary prevention of cardiovascular events following the clinical manifestation of atherosclerotic disease.
This article discusses the evidence for and role of aspirin in the secondary prevention of cardiovascular events following the clinical manifestation of atherosclerotic disease.
Insomnia is a common condition in which patients experience difficulty initiating sleep, maintaining sleep and/or wake earlier than desired. It can cause significant distress and impaired functioning.
Population surveys suggest that approximately 33% of the population experience at least one insomnia symptom, with only 1 in 10 seeking treatment. Female gender, older age, pain and psychological distress have all been associated with increased prevalence rates.
There is a strong association between insomnia and psychiatric disorders, such as depression, anxiety, and drug abuse. Rates of psychiatric comorbidity as high as 80% have been reported, with insomnia predating the onset of mood disorder in approximately half of cases. Insomnia has also been independently associated with increased healthcare utilisation, increased workplace injuries and absenteeism, and reductions in quality of life. A number of studies have demonstrated an association between insomnia and increased cardiovascular risk.
The management of insomnia can broadly be categorised into pharmacological and non -pharmacological therapies. Although pharmacotherapy is often used first by doctors and as primary therapy, it is not indicated long term and should not be used in isolation. Pharmacotherapy is only indicated for short term use. Benzodiazepines, non-benzodiazepine hypnotics, melatonin, sedating anti-depressants and antipsychotics have all been used. The majority of these agents have been shown to be more efficacious than placebo in short term randomised controlled trials, however their use is often tempered by extensive side effect profiles, detrimental effects on sleep architecture and the risk of tolerance and dependence.
Non-drug treatments for insomnia, namely Cognitive Behavioural Therapy (CBT) for sleep are very effective both acutely and for the longer term. CBT for sleep should be initiated in all patients. CBT is effective as a sole treatment for insomnia or it may reduce the reliance on medications in the longer term. CBT addresses dysfunctional behaviours and beliefs about sleep and consists of sleep hygiene, stimulus control, sleep restriction, and cognitive restructuring.
In the past, access to CBT for sleep has been a challenge, with limited trained providers and poor availability. However, recent studies of computer based (online) CBT for sleep have been encouraging with comparable efficacy to conventional CBT for sleep. Online CBT can be accessed in Australia through the US based SHUTi program if referred by GP’s or Specialists (http://www.sleepcentres.com.au/online-insomnia-cbt-program.html). Online CBT for sleep is convenient, effective and easy to access, and arguably is a good option for non-drug insomnia management for all patients.
Sleepiness is a complex issue and we need to explore the clinical context and other possibilities before arriving at the decision to perform a sleep study
Become familiar with breathing disorders that are not obstructive sleep apnoea and non-respiratory sleep disorders. Learn how to take a sleep history and how to structure our approach to the sleepy patient
How to interpret a sleep study more effectively, why you should not skip the sleep physician's conclusions, and how to understand the graphs and hypnograms
The role of the sleep psychologist, Insomnia - learn how to take a detailed history and how this can lead us toward a nuanced diagnosis, and therefore a more appropriate management plan. Additionally, how CBT is the first line treatment for insomnia, and it is far more than sleep hygiene
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