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MAOI/antidepressant patient feeling worse with CPAP
#11
I agree about the oximetry study.

And about needing more information about your data.
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#12
Everyone,

Thanks for your suggestions and support. Sorry I didn't respond sooner, but I was away visiting family during the holidays.

I'll respond more specifically to some of your suggestions soon, and I will try to post my data. But, out of desperation, I went back and reviewed the results of my sleep study from a year ago which has raised some significant concerns for me. The study summary showed the following results from the titration portion:

BiPAP Pressure, % of Time in REM, AHI, RDI
9/5, 0%, 3.49, 73.8
11/7, 6%, 1.9, 27.0
13/9, 18%, 0.0, 5.3

My doctor started me at 9/5 (with full face mask) with the intent of moving me up to 13/9. After several months I was at 11/7 and was having gas and some bloating. Due to the "swallowing air" side effects at this pressure, my doctor moved me over to a nasal mask instead of a full mask and changed the pressure to 8/4. I never went up to 13/9. After being at 8/4 on the nasal mask for a few weeks, the doctor downloaded the data from my BiPAP SD card. The data showed that my AHI was below 1.0, and that is when the doctor said I was "cured" of my sleep apnea. This was a few weeks ago. Of course, I felt absolutely exhausted during the data collection period (as I always do).

These are my questions / concerns that have come up:

1) I've read on line that RDI is just as important of an indicator of sleep apnea as AHI. As you can see from my table above, by RDI was significantly higher than my AHI at all pressures during my sleep study. Since I never even got to a pressure of 13/9 at home, and I don't know what my RDI is using the nasal mask at 8/4, is it possible that my AHI is low but my RDI is high and my sleep apnea has therefore never actually been treated effectively? My Respironics SystemOne BipPap machine does not seem to record/report the RDI index.

2) I've read that both Parnate and Lithium can completely supress REM sleep. It seems that that might be the case for me, since I got zero REM sleep at 9/5, and only 6% at 11/7. I've read that normal REM sleep should be around 20% of total sleep time. I've read contradictory information on the importance of REM sleep, some articles saying it is critical for restorative sleep. Others say that REM suppression is frequently caused by anti-depressants, and the suppression can in fact be beneficial in treating depression. What is your understanding of the importance of REM sleep? I brought REM suppression up to both my psychiatrist and sleep doctor and neither seemed to be concerned about it.

Thanks for all your help. My extreme fatigue, fogginess, memory, and cognitive impairment are getting worse and worse. I'll be seeing a neurologist this week at the recommendation of my primary care and sleep doctors. I forgot to mention, I've had extensive blood work and a cranial MRI to rule out cancer, tumors, MS, and other conditions that might cause my symptoms. I'm 47, so I am a bit young for Alzeimer's, etc. Out of frustration, I'm re-examining my sleep apnea treatment to try an figure out the cause of my symptoms. If the neurologist clears me, then I'll be really hitting my psychiatrist and sleep doctor up hard for some answers.

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#13
Cpapstruggler,

If the neurologist clears you, I hope you do hit your psychiatrist and sleep doctor hard on the issue of the Parnate and Lithium even if it means having to get 2nd or 3rd opinions. The issues I would be addressing are do you still need to be on the meds and if so why, if you need to be on them, is it possible to lower the dose or are there substitutes that would work as well but cause less side effects? If you decide to go off of the meds or lower the dose in consult with your docs, be sure to do it very slowly to avoid withdrawal symptoms.

Best of luck.

49er
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#14
How long did it take to get rid of the antidepressants after you started CPAP treatment?

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#15
Struggler, so sorry for what you are going through. I am not a medical professional but have been on every type of antidepressant you can name, and have struggled w/ sleep problems, so I can relate. Have you ever tried Remeron? I was on it for two years. It is a different type of antidepressant taken at bedtime, and helps a lot with sleep, so if your fatigue symptoms are from your meds preventing deep sleep, it may be one to consider.

My first few days on it, I felt really foggy and out of it and could not drive or go to work, but w/ in a few days, I felt pretty good, and it helped with the depression I was having.

Many people gain weight on it. I gained only 10 pounds over the two years, but the med worked well for me when many others didn't. It might be worth asking the doctor about.

Sleep-well
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#16
Hi cpapstruggler,

As others have suggested, get your oximetry tested while asleep. You can purchase one and do it yourself relatively easily.

Haven't ever used lithium or parnate but have been on every benzo, and always noted that the 'quality' of sleep was always poorer on a benzo. Much like alcohol-sleep. Have been on valproate and lamotrigine but never noticed anything sleep-wise. Never used these two in conjunction with cpap, though and the benzos were always the same with or without cpap.

Whether you're taking xanax for anxiety or sleep, messing with the dosage is very tricky without knowing your psychiatric history and dosage so discuss with your doctor about doing without it for a week.
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