Waking up to Sleep: A GP’s view

GP Dr Bill Vennells of Devon Doctors went along to the Waking up to Sleep conference, hosted by the University of Exeter Medical School, to gain a bit of understating and add to his professional knowledge.

Image courtesy of Shutterstock.

Image courtesy of Shutterstock.

Here am I in semi-retirement back in Medical School. The last time I was in a lecture theatre was the late 1970s. Numerous courses over many years, a variety of training and conference centres, but this course means serious business.

I learned that Rapid Eye Movement sleep helps process short term memory and counters dementia. Presentations started from first principles so we understood clinical practice. The phases of sleep were elucidated and daily Circadian rhythm patterns were clearly demonstrated.

The twists and turns in presentation kept our attention. Professor Zeman interviewed his patient about her sleep problems; Dr Whitehead lay down with a pillow on the floor for a masterly performance of Obstructive Sleep Apnoea.

I was gratified to find that my Epworth score, a measure of sleepiness, was four. Quite alert then.

The treatments for sleep disorders all work in some patients. Xyrem, a more recently available stand-alone chemical compound is, however, more effective than others.

A frustrating fact of life in General Practice is the non-availability of proven effective treatments. We discovered that this is true of Cognitive Behavioural Therapy for insomnia, recommended by NICE. The human mind is awkward and paradoxical and will resist the will to sleep. A gentle effort to stay awake is apparently the best approach to insomnia.

Other relevant facts:

  • 12 seconds of apnoea is normal under two months of age.
  • SIDS is associated with carbon dioxide build up around the nose and mouth and a reduced gasp reflex. Sadness was tangible amongst the audience.
  • Baby sleeping with Mum is risky, beware of unplanned drowsing, and alcohol – I recalled a particular tragic case.
  • “Those who say they have slept like a baby have never had one.” A good aphorism from Rachel Howells before lunch.

Over lunch I interacted with a colleague from Devon Doctors, a semi- retired Psychiatrist, a GP who did more sessional work in the winter to have more free time in the summer, and a Dutch GP who told me that in Holland GPs work in Nursing Homes. I talked to a narcolepsy sufferer whose father knew Sigmund Freud.

After lunch I learned that Sleep Apnoea was associated with depression and reduced libido. Sleepiness has a greater effect on driving error than alcohol and the great majority of accidents involve young men.

The interactive case studies after lunch were another helpful twist, linking learning to experience.

The effectiveness of antidepressants is related to their effect on REM sleep and this can predict their effectiveness. Nightmares are associated with a fivefold increase in suicides.

The day kept my attention, and enabled a lot of material from multi-disciplinary sources to be presented. The timetable available to us beforehand clearly signposted the areas to be covered, the presentations had clear summaries including take-home messages. I went home rather tired but I had added to my pool of useful information and understanding.

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