RE: MAOI/antidepressant patient feeling worse with CPAP
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.
(This post was last modified: 01-04-2016 12:41 AM by CPAPstruggler.)