Behind the Episode: Obstructive Sleep Apnea: Do Mental Health Providers Have a Role?
For a long time, when it came to working with Obstructive Sleep Apnea (OSA) as a behavioral health provider, my understanding was that my role ended once I successfully referred the patient to a physician (either their primary care provider or a sleep medicine physician). I understood that OSA was a potentially dangerous condition that required a thorough assessment and medical intervention. At best, I could assist by screening the patient for OSA and getting them connected to treatment.
Listen to the full discussion here: Obstructive Sleep Apnea - Do Mental Health Providers Have a Role?
As our understanding of OSA has evolved, so has the role that behavioral health providers might play. In addition to screening, we might play a role in increasing patients’ adherence to recommended treatment and working through inaccurate expectations. With expanding research on comorbid insomnia and sleep apnea (COMISA), we’ve learned that we can further support patients whose OSA is only part of the picture.
On this episode of CDP’s Practical for Your Practice, we’re joined by Dr. Phil Gehrman. Dr. Gehrman is a renowned sleep medicine researcher and clinician. In addition to defining OSA, he describes how behavioral health providers can take a more active role in supporting their patients with OSA. In fact, he describes us as an “untapped” resource.
In regards to its definition, OSA is a common sleep disorder where breathing repeatedly stops and starts due to a temporary blockage of the upper airway during sleep. This happens when any of our soft tissue – tongue, throat, uvula, etc. – relaxes and obstructs the airway. These obstructions can last 10 seconds or longer, leading to a drop in blood oxygen levels. The brain senses this lack of oxygen, briefly waking the person to resume breathing, often accompanied by a gasp or snort. This cycle can occur dozens or even hundreds of times a night, preventing deep, restorative sleep and depriving the brain and body of oxygen. As a result, OSA increases the risk of serious health issues including high blood pressure, heart attack, stroke, and irregular heart rhythms (arrhythmias). Chronic sleep deprivation from OSA can also lead to excessive daytime sleepiness, impairing concentration, increasing the risk of accidents (especially while driving), and contributing to mood changes like irritability and depression.
Once diagnosed, Continuous Positive Airway Pressure (CPAP) therapy is the gold standard, but adherence is a significant hurdle. Many patients struggle with the discomfort of wearing a mask nightly, dry throat/nose, claustrophobia, and the perceived inconvenience of the machine. The initial adjustment period can be challenging, leading to high rates of non-compliance (often as high as 30-50%). Other treatment options are available for OSA, but they come with their own risk/reward profile.
As we discuss in today’s episode, behavioral health providers can assist patients with OSA in a variety of ways, including:
- Screening patients for OSA and facilitating referrals
- Using motivational interviewing and other techniques to increase motivation for and adherence to OSA treatment
- Addressing unhelpful cognitions or expectations regarding OSA treatment
- Facilitating behavior change related to weight management, which can improve outcomes for patients with OSA
- Treating insomnia disorder, which is often comorbid with OSA
If you are seeing an increase in OSA in your practice, you may be able to help them in ways you had not considered before. Improving your patients’ sleep – and their blood oxygen! – is likely to have a more global impact on their health and functioning. Tune in to this episode of Practical for Your Practice to learn more about what you can offer.
By the way, this episode marks the end of Season 6 of Practical for Your Practice! Thank you to our listeners. Please continue to listen, subscribe, share, and send in your feedback. If you’re new to the P4P Podcast, we hope you’ll check out previous seasons. And we hope you will all tune back in for Season 7!
Listen to the full discussion here: Obstructive Sleep Apnea - Do Mental Health Providers Have a Role?
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Lefkowitz earned her M.A. and Psy.D. in clinical psychology at Widener University, with a concentration in cognitive-behavioral therapy.
For a long time, when it came to working with Obstructive Sleep Apnea (OSA) as a behavioral health provider, my understanding was that my role ended once I successfully referred the patient to a physician (either their primary care provider or a sleep medicine physician). I understood that OSA was a potentially dangerous condition that required a thorough assessment and medical intervention. At best, I could assist by screening the patient for OSA and getting them connected to treatment.
Listen to the full discussion here: Obstructive Sleep Apnea - Do Mental Health Providers Have a Role?
As our understanding of OSA has evolved, so has the role that behavioral health providers might play. In addition to screening, we might play a role in increasing patients’ adherence to recommended treatment and working through inaccurate expectations. With expanding research on comorbid insomnia and sleep apnea (COMISA), we’ve learned that we can further support patients whose OSA is only part of the picture.
On this episode of CDP’s Practical for Your Practice, we’re joined by Dr. Phil Gehrman. Dr. Gehrman is a renowned sleep medicine researcher and clinician. In addition to defining OSA, he describes how behavioral health providers can take a more active role in supporting their patients with OSA. In fact, he describes us as an “untapped” resource.
In regards to its definition, OSA is a common sleep disorder where breathing repeatedly stops and starts due to a temporary blockage of the upper airway during sleep. This happens when any of our soft tissue – tongue, throat, uvula, etc. – relaxes and obstructs the airway. These obstructions can last 10 seconds or longer, leading to a drop in blood oxygen levels. The brain senses this lack of oxygen, briefly waking the person to resume breathing, often accompanied by a gasp or snort. This cycle can occur dozens or even hundreds of times a night, preventing deep, restorative sleep and depriving the brain and body of oxygen. As a result, OSA increases the risk of serious health issues including high blood pressure, heart attack, stroke, and irregular heart rhythms (arrhythmias). Chronic sleep deprivation from OSA can also lead to excessive daytime sleepiness, impairing concentration, increasing the risk of accidents (especially while driving), and contributing to mood changes like irritability and depression.
Once diagnosed, Continuous Positive Airway Pressure (CPAP) therapy is the gold standard, but adherence is a significant hurdle. Many patients struggle with the discomfort of wearing a mask nightly, dry throat/nose, claustrophobia, and the perceived inconvenience of the machine. The initial adjustment period can be challenging, leading to high rates of non-compliance (often as high as 30-50%). Other treatment options are available for OSA, but they come with their own risk/reward profile.
As we discuss in today’s episode, behavioral health providers can assist patients with OSA in a variety of ways, including:
- Screening patients for OSA and facilitating referrals
- Using motivational interviewing and other techniques to increase motivation for and adherence to OSA treatment
- Addressing unhelpful cognitions or expectations regarding OSA treatment
- Facilitating behavior change related to weight management, which can improve outcomes for patients with OSA
- Treating insomnia disorder, which is often comorbid with OSA
If you are seeing an increase in OSA in your practice, you may be able to help them in ways you had not considered before. Improving your patients’ sleep – and their blood oxygen! – is likely to have a more global impact on their health and functioning. Tune in to this episode of Practical for Your Practice to learn more about what you can offer.
By the way, this episode marks the end of Season 6 of Practical for Your Practice! Thank you to our listeners. Please continue to listen, subscribe, share, and send in your feedback. If you’re new to the P4P Podcast, we hope you’ll check out previous seasons. And we hope you will all tune back in for Season 7!
Listen to the full discussion here: Obstructive Sleep Apnea - Do Mental Health Providers Have a Role?
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Lefkowitz earned her M.A. and Psy.D. in clinical psychology at Widener University, with a concentration in cognitive-behavioral therapy.