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[Symptoms] Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
#1
Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
Hi everyone.

Can sleep apnea manifest itself mainly via cognitive symptoms (poorer memory, inability to reason, poor concentration...) and without fatigue ?Below is the complete story in summary and my symptoms.

My father has sleep apnea. I'm a man, I'm fat. I wake up sometimes (once every 3 or 4 months) feeling like I'm choking/drowning, I might have high blood pressure (but it might be a consequence of my diet) since everything began. I did a STOPBANG test found on the net and I got a 5/8 (the method is not rigorous, I know, but since it's only a score, I guess it's not that unreliable).

It all started around October 2020. At the time I had been on 50mg daily of Sertraline (an SSRI) for about ten months to treat OCD. I felt like I had lost 50 IQ points, just like that, for no reason, I felt dumber than a few months before. I told my psychiatrist about it and he said it was probably a side effect of the antidepressant. It was annoying, but I didn't worry about it any more than that until I went completely off the meds in January 2022. These symptoms never went away and seem to indicate sleep apnea, I have an appointment with a doctor before I do a sleep study around the fifteenth of May.

Snoring: I snore loudly according to those around me.

Interrupted breathing in my sleep: According to someone close to me, this has already happened. Also, I sometimes wake up feeling like I'm drowning.

Cognitive Problems: I have always understood everything fairly quickly, in fact I don't remember ever having trouble understanding anything. Now everything takes me forever to figure out when I do, even things I used to know I understood (I can't recognize the pattern of a simple cross product anymore). I used to be able to concentrate well, this is not the case anymore, reading a simple newspaper article can be complicated sometimes. I used to love to read philosophy books, I can't do it anymore (including books I've already read where I got something out of them). I basically feel like I've lost 50 IQ points. I feel dumb.

Memory problems: I have often been suspected of being hypermnesic (no idea if this is the case, knowing this would be useless). I have always had a very good memory, almost a photographic memory at times, this is no longer the case at all.

Dry mouth in the morning: It's been happening less in the last few days but it was quite regular in the last few months.

I guess it seems pretty obvious that it's sleep apnea, but here goes... I'm not tired. All this makes me doubt and I don't know where to turn (my appointments with my doctor and then my sleep study will take place in about 10 days). So I wonder if it is possible to have sleep apnea without fatigue hence my question at the beginning of the post.

I hope I didn't make a mistake in translation, English is not my native language. I apologize if there are any mistakes in the text.
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#2
RE: Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
Absolutely!

But to preface, OSA doesn't make you "fatigued" it makes you "sleepy". There's a big difference.

With that in mind, and using ESS as a gauge, SHHS showed that more than 50% of individuals with moderate-to-severe OSA were not subjectively sleepy as assessed by ESS.

What does "might" have high blood pressure mean?

If you've done any research at all you know that SSRI can scramble your brain.

Given your other symptoms, get the study. Then you can make an informed decision.
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#3
RE: Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
(05-12-2022, 10:16 AM)LarissaH Wrote: But to preface, OSA doesn't make you "fatigued" it makes you "sleepy".  There's a big difference.

With that in mind, and using ESS as a gauge, SHHS showed that more than 50% of individuals with moderate-to-severe OSA were not subjectively sleepy as assessed by ESS.

What does "might" have high blood pressure mean?

If you've done any research at all you know that SSRI can scramble your brain.
I don't feel sleepy either.

We are not sure if my high blood pressure is chronic or occasional.

SSRIs can indeed scramble the brain, but the effects fade after withdrawal. I've been weaned for several months now, so there's no reason for it to be from that according to my psychiatrist.
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#4
RE: Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
(05-12-2022, 03:43 PM)NotNotLaosho Wrote: SSRIs can indeed scramble the brain, but the effects fade after withdrawal. I've been weaned for several months now, so there's no reason for it to be from that according to my psychiatrist.

OK but IYAM, this is a smoking gun:


(05-12-2022, 03:43 PM)NotNotLaosho Wrote: It all started around October 2020. At the time I had been on 50mg daily of Sertraline (an SSRI) for about ten months to treat OCD. I felt like I had lost 50 IQ points, just like that, for no reason, I felt dumber than a few months before. I told my psychiatrist about it and he said it was probably a side effect of the antidepressant. It was annoying, but I didn't worry about it any more than that until I went completely off the meds in January 2022. These symptoms never went away.


You got 3 choices:

1.  Sleep apnea (and from what you describe it may be at least a contributor).
2.  Persistent brain fog secondary to SSRI use.
3.  Something else.
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#5
RE: Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
(05-13-2022, 05:45 AM)LarissaH Wrote: You got 3 choices:

1.  Sleep apnea (and from what you describe it may be at least a contributor).
2.  Persistent brain fog secondary to SSRI use.
3.  Something else.

To be honest, the fact that it's due to SSRIs scares me a lot, but there are no studies (or I didn't look hard enough) that show that the side effects last more than a few weeks after withdrawal (I had a slow withdrawal, by the way). 

My psychiatrist tells me it's not possible, I trust him on that (he's not the type to prescribe stuff for no reason.
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#6
RE: Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
Out of curiosity has your psychiatrist recommended trying an snri?
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#7
RE: Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
(05-13-2022, 08:37 AM)Geer1 Wrote: Out of curiosity has your psychiatrist recommended trying an snri?

No, we didn't want to take the risk of having to change again afterwards. Before the antidepressants, I had a rather severe OCD (the kind of thing that made me ruminate 10 hours a day), I didn't want to fall back into it by changing medication
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#8
RE: Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
Being on the SSRI for 10 months before these symptoms set in would make me think it is unlikely the SSRI caused them. Sounds like your psychiatrist doesn't believe this to be the case either.

Reason I was curious about SNRI is because we have a couple similarities and an SNRI has worked wonders for me. Cognitive problems like brain fog if you want to call it that, memory issues like forgetting words or names sometimes literally mid thought, dry mouth and nose (to the point I had started using nasogel and biotene mouthwash nightly). I also have chronically tight muscles and no energy/fatigued feeling (have wondered if I have CFS etc). All of this has improved on SNRI (50 mg Pristiq). Brain slowly shedding the cobwebs, have barely touched the nasogel or biotene, muscles relaxed in first 24 hours and keep on improving (been seeing physiotherapist due to fractured neck and he noticed an objective improvement 3 days later), energy much better even though sleeping less (one downside of norepinephrine although combined with dayvigo I get enough sleep). SSRIs in the past have helped with some of the mood/anxiety but always left me feeling unmotivated and a bit off, the energy from norepinephrine seems to make a big difference in helping my specific case. Obviously good to trust your psychiatrist, if you start running out of options it might be worth considering though.

As for the apnea side it is worth looking into but I would think cognitive effects alone without either a sleepy/tired or fatigued feelings is probably unlikely as apnea usually causes one or the other due to the symptoms being caused by poor sleep quality due to apnea effects. The results of sleep study should help determine if it is a factor. Are you doing an in clinic or home sleep study?
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#9
RE: Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
About SNRIs:
Normally I don't need medication anymore, I'd rather not medicate myself with this stuff unless it's absolutely necessary but that's good to know, I keep that in the back of my mind.

About the apnea side:
My reasoning is this: I am young, my days are very empty. Therefore, I tell myself that I may be tired but I don't feel anything because... well, I'm not doing anything. Besides, there's something I didn't mention because I didn't want to mislead people who would answer me: I've had a strange feeling for a few months now, the impression during the day that if I lay down in the dark, I'd fall asleep in five minutes. I wouldn't say it's drowsiness though.
Also, I imagine that if I have repeated hypoxia (just a hypothesis, I have no proof of that), it has more to do with my cognition than with my fatigue.
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#10
RE: Can sleep apnea manifest itself mainly via cognitive symptoms and without fatigue ?
You can most certainly have sleep apnea without feeling a need to sleep during the day, if that's what you're asking, and it can most certainly cause cognitive and mood symptoms. I've been following your thread on another forum, and I'll be curious to know what your sleep study shows.

It can be difficult to get a diagnosis when primary symptoms are "subjective." I'm not sure exactly how to capture the nuances in French, but careful users of English will see differences among "sleepy," "tired," and "fatigued." Using more words may be helpful to the diagnostic process. So, for example, someone might say they feel a strong urge to take a nap during the day, or they want to sit or lie down after walking a block, or it takes them a big act of will to move. Those may suggest different causes to an attentive doctor.
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