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MAOI/antidepressant patient feeling worse with CPAP
#1
Hello All - A little history on me. I was diagnosed with severe sleep apnea a year and a half ago. I have been religiously using a BiPAP for a year now. After some tinkering with pressures and masks, the sleep doc was able to get my AHI down below 1. I am sleeping between 7 and 8 hours per night.

I am extremely frustrated because even thought my sleep apnea has been technically "cured", I swear I feel more tired than before I started using a BiPAP. I don't feel drowsy, but I do feel run down, physically tired, forgetful, spacey, and have difficulty concentrating. The fatigue is to a point that it is significantly affecting my work and general functioning. I am afraid to go off the BiPAP to experience my no-BiPAP baseline for fear of all the negative health effects of untreated apnea (cardiac, etc.).

I have suffered with anxiety and depression for more than 20 years. After trying numerous SSRI's over the years, my psychiatrist put me on Parnate (an MAOI) for my "treatment resistant" depression about three years ago. It has worked like a miracle drug for me, dramatically reducing my depression. I'm also on lithium and Xanax. I know what it can feel like to be sleep due to medication, and I of course know what it feels like to not get enough sleep. But the fatigue I have felt ever since starting the CPAP is something different.

I'm beginning to think that my new "apnea free" body is negatively interacting with the MAOI that has been so beneficial up until this point. I have read that MAOI's and lithium both almost completely eliminate REM sleep. I'm not clear on whether there is a direct connection between my symptoms and REM sleep loss. Since I have experienced the pain of severe depression, I am reluctant to try and go off the Parnate. I believe I have a good psychiatrist and and sleep doc, but they don't seem to know what's going on (they have consulted with each other on my case). I'm afraid to go of the psychiatric drugs, but I'm afraid to stop apnea therapy.

My questions are, have any of you:
1) Simply felt worse once they started using a CPAP/BiPAP, even over a long period of time and with a low AHI?
2) Experienced a negative interaction between CPAP/BiPAP therapy and MAOI's, lithium, or Xanax?

Any thoughts you have would be greatly appreciated!
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#2
(12-10-2015, 06:54 PM)CPAPstruggler Wrote: My questions are, have any of you:
1) Simply felt worse once they started using a CPAP/BiPAP, even over a long period of time and with a low AHI?
2) Experienced a negative interaction between CPAP/BiPAP therapy and MAOI's, lithium, or Xanax?

1) There are people who say they feel worst on CPAP over time. The reason is unknown in most cases.

2) I think those meds are a bit out of the general knowledge of this board. I'd suggest coordinated care with the sleep doc and the prescribing doc talking to each other.

If it's not too personal, may I ask how long you have been prescribed Xanax?
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
Hello struggler -- I'm not an M.D. but in my professional life I talk with people frequently who are trying to make decisions about going on or going off medications. One thing I see is that it's easy to get caught up in a feeling that any decision you make (going on or off, changing dosage, etc.) is an irreversible lifetime commitment, and that makes the decision feel bigger and more daunting than it needs to be. Generally these decisions are not irreversible. Check with your docs about whether this holds true in your case with your meds. When you know you can return to the therapeutic dose you were on, the decision to try a change becomes much less stressful.
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#4
Struggler,

I am also not an MD so keep that in mind as you read my post. This is strictly anecdotal but it seems many people diagnosed with psych conditions who turn out to have sleep apnea find they either don't need the meds or do better with a reduction. Hard for me to explain but let me take a shot.

When you are not getting good quality sleep, you are going to be understandably depressed and anxious which may necessitate taking meds. But once you are, then the meds may no longer be necessary and in fact can be a hindrance.

Now whether this is true in case, I obviously can't say. Maybe you want to talk to your psychiatrist about doing a very slow taper to see if the fatigue goes away? It doesn't necessarily mean going off the meds but just to see if a lower dose might work. Just a thought and of course, discuss everything with your doctors.

49er

(12-10-2015, 06:54 PM)CPAPstruggler Wrote: Hello All - A little history on me. I was diagnosed with severe sleep apnea a year and a half ago. I have been religiously using a BiPAP for a year now. After some tinkering with pressures and masks, the sleep doc was able to get my AHI down below 1. I am sleeping between 7 and 8 hours per night.

I am extremely frustrated because even thought my sleep apnea has been technically "cured", I swear I feel more tired than before I started using a BiPAP. I don't feel drowsy, but I do feel run down, physically tired, forgetful, spacey, and have difficulty concentrating. The fatigue is to a point that it is significantly affecting my work and general functioning. I am afraid to go off the BiPAP to experience my no-BiPAP baseline for fear of all the negative health effects of untreated apnea (cardiac, etc.).

I have suffered with anxiety and depression for more than 20 years. After trying numerous SSRI's over the years, my psychiatrist put me on Parnate (an MAOI) for my "treatment resistant" depression about three years ago. It has worked like a miracle drug for me, dramatically reducing my depression. I'm also on lithium and Xanax. I know what it can feel like to be sleep due to medication, and I of course know what it feels like to not get enough sleep. But the fatigue I have felt ever since starting the CPAP is something different.

I'm beginning to think that my new "apnea free" body is negatively interacting with the MAOI that has been so beneficial up until this point. I have read that MAOI's and lithium both almost completely eliminate REM sleep. I'm not clear on whether there is a direct connection between my symptoms and REM sleep loss. Since I have experienced the pain of severe depression, I am reluctant to try and go off the Parnate. I believe I have a good psychiatrist and and sleep doc, but they don't seem to know what's going on (they have consulted with each other on my case). I'm afraid to go of the psychiatric drugs, but I'm afraid to stop apnea therapy.

My questions are, have any of you:
1) Simply felt worse once they started using a CPAP/BiPAP, even over a long period of time and with a low AHI?
2) Experienced a negative interaction between CPAP/BiPAP therapy and MAOI's, lithium, or Xanax?

Any thoughts you have would be greatly appreciated!

Post Reply Post Reply
#5
(12-10-2015, 06:54 PM)CPAPstruggler Wrote: My questions are, have any of you:
1) Simply felt worse once they started using a CPAP/BiPAP, even over a long period of time and with a low AHI?
2) Experienced a negative interaction between CPAP/BiPAP therapy and MAOI's, lithium, or Xanax?

Welcome CPAPstruggler, as justMongo expressed, we might be able to offer some insight on the first point, but no one here is qualified to be giving you advice concerning drug interactions as it relates to your CPAP/BiPAP therapy. That kind of advice needs to come from your personal physician.

So, while folks can offer suggestions to you regarding your sleep apnea treatment, please keep in mind that you should not regard anything posted on Apnea Board as medical advice.

Coffee
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.



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#6
Have you had an overnight oxymetry since you've been on the PAP machine? You might be like me - I had a very low AHI on the machine but still felt worse and worse. An overnight oxymetry proved that my O2 levels were still very low much of the night even though I was having hardly any "events". I was placed on an oxygen concentrator as well as the APAP and that's when I started to get better. Might be worth checking.
Ed Seedhouse
VA7SDH

I am neither a Doctor, nor any other kind of medical professional.

Actually you know, it is what it isn't.
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#7
(12-10-2015, 06:54 PM)CPAPstruggler Wrote: I don't feel drowsy, but I do feel run down, physically tired, forgetful, spacey, and have difficulty concentrating. The fatigue is to a point that it is significantly affecting my work and general functioning.

Two things. First, we can help you look at your data and see if there are issues with things like leaks. If you are spending significant amounts of time in large leak, that can ruin your sleep quality. My sleep doc looks at summaries and would miss things like this, so I have to bring them to her attention. I switched to a full face mask to fix mine. I see that you are using a nasal mask, so if you are mouth-leaking and a chin strap doesn't help, a full face mask is what you need. The leak statistics are not enough, you have to look at the leak graphs, too. I started sleeping better and feeling better when I made that switch almost a year ago.

The second thing is your mental health providers. I know it's hard to switch doctors when you find one you like, but sometimes a second opinion is needed. It could be that the medications are sedating you. This is something that you really don't want to adjust on your own. I was lucky because after starting CPAP therapy I worked with a psychiatrist who used other medications to ween me off the antidepressant I was taking. Side effects are a huge issue with antidepressants, and you definitely don't want to just stop taking them without the full cooperation of a qualified doctor.

I don't know if your psychiatrist is also providing psychotherapy. Mine wasn't. It took me three series of sessions with a psychotherapist over a period of about five years but it was worth it. I was suffering with anxiety, anger issues, chronic headaches, and teeth grinding. These symptoms developed over decades of untreated sleep apnea and after I started CPAP therapy it took a couple years for them to fade away. The last of these symptoms is insomnia and I'm slowly winning that battle, too. It took a lot of courage to face my issues. They weren't all caused by sleep apnea, but some were, and the ones that weren't were made much worse by untreated sleep apnea.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
Hi CPAPstruggler,
WELCOME! to the forum.!
I wish you much success with your CPAP therapy and getting your depression and sleep problems straightened out..

trish6hundred
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#9
Congrats. You are absolutely in the right place.
I was on a variety of anti-depressants for about 40 yrs. Then I began CPAP therapy and no longer use AD's. I know now I have experienced OSA since my teens.
I am NOT suggesting you stop.
I have also discussed with a friend of mine (Psych Prof at a local University) the first thing he might consider for anyone coming to see him with depressive symptoms is a sleep apnea screening and having seen the changes in me over the last 7 mos he is giving it serious thought.
I do suggest you install SleepyHead and post some screen shots.
After you get up to speed with SH you can then look at this thread http://www.apneaboard.com/forums/Thread-...s-the-bomb and see if you can relate.
I wish you well.
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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#10
I take low-dose Xanax (0.25mg), and I don't think it affects my CPAP therapy at all. I'll stop it once I feel that I no longer need it. I don't like the idea of taking Benzos for the long term.
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