Initially misdiagnosed

[ZZZzzz]

ANYBODY who's sleep deprived over a period of time will become depressed and start to show mental stress fractures.
It manifests itself differently from person to person.

I never had the classic daytime drowsiness with Apnea but I sure had daytime rage from being so tired and consuming excessive caffeine.

-Bev

[RosemaryB]

I was diagnosed with ADHD and put on meds for it.

The meds did help me pay attention, but also messed with my sleep big time! I was getting very little sleep and I was becoming depressed. I decided just to live with the ADHD because the meds were so uncomfortable.

The funny thing is that at least some of the ADHD symptoms seem to have abated in the past month on the apnea treatment. I can type without making multiple errors, for one thing.

Another thing I noticed in the past was when I didn't get enough sleep some depression symptoms would creep in very quickly. I suspect apnea was a contributing factor to this. This week I had one 5.5 hour night and did not feel depressed at all, just somewhat tired.

[jskinner]

However, my psychiatrist was the one that thought I may have a sleep disorder as well and when he referred me to the sleep doc, she tried to tell me it was JUST depression.

I had a similar experience. In 2004 I was sent to a sleep doctor but he would not do a sleep test because he felt my problem was all in my head. I suffered along for another year and was eventually sent back to him. By then I had almost every symptom of sleep apnea, when I told him he suggested that maybe I was a hypochondriac! He would not back down from his original diagnosis.

Luckly my GP eventually agreed to get me tested at a different clinic. Bingo severe sleep apnea... I too has been saying for years that I thought my problems where largely linked to my sleep. Pretty frustrating that it could (and should have) been caught two years earlier and the first sleep doctor tested me...

[snoozeandlose]

I started on antidepressants after years of talk therapy. Prozac literally changed my life and was able to go back to school at 40+ and completed a rigorous allied medical program (second degree). Doc considered my depression treatment resistant and possibly genetic.

During this time I was dxed with OSA with the symptom being snoring. I did not snore at all when I was younger and thinner. CPAP helped my fatigue. After a few years the fatigue got worse and adjustments to my OSA treatment didn't help. I had ADD symptoms and my docs tried me on Ritalin and Adderall. Didn't help much. As time passed I became more tired, more forgetful and spacy. Started having problems at work and tried Adderall XR which did seem to help at this point.

During my third sleep study my sleep doc told me I have alpha intrusion causing me to be severely sleep deprived. I have been on Xyrem--yes while taping my mouth and using CPAP. Great improvement, but still have excessive daytime sleepiness. After extensive reading on narcolepsy I appear to have the two necessary symptoms--REM disturbance and ability to fall asleep under five minutes during the day. My depression has improved immensely. Hope to start Provigil soon and continue on Xyrem.

My sleep doc said most people with alpha intrusion are misdiagnosed with depression, when it is really sleep deprivation. My initial diagnosis of depression was correct and made before the sleep apnea started. In the meantime, I think I developed the sleep disorders which were confused with depression symptoms. The doc thinks I will be able to cut back on the antidepressants. I have only my own perseverance to thank for solving this because the docs would have missed it if I hadn't keep questioning them. CPAPer heal thyself?

[John_M]

I am writing this in a state of shock as I have just had a "synchcronicity" attack.

I was off investigating Heart Rate Variability ,HRV, (more about this later) and discovered it was connected with Sleep Apnea and they even had a conference on it in the past. So My question is where does HRV fit in the Sleep Apnea scene.

But right now I want to get into the shock of synchronicity.

So once up a time developed an interest in depression and was diagnosed as a bipolar cos I made a suicide attempt. I though that this had nothing to do with sleep apnea until I started meeting others on this forum who claimed to have been incorrectly diagnosed with bipolar and depression and had been "cured" by the application of a CPAP machine. Huhh!!!

And then I went to a Dr last week to expand my esophagus and he tells me I have ulcers in my esophagus and I suddenly remember that you guys have been warning me about GERD for a while. So my esophagal ulcers are related to Sleep Apnea Huhh!!!

And then I have been working on stress reduction for years. I get a book "The instinct to heal" and it trys to relate sympathetic and parasympathetic systems and stress and all that and it says that "Coherence" and Heart Rate Variability is part of this stuff. So I get a bio-feedback game "Wild Divine" and start trying to control my Heart Rate Variability. And then I search on the internet for Heart Rate Variability and find that people are working on studying its connection with Sleep Apnea and even trying to use it as a screening tool for Sleep Apnea! Huhh!

So how do depression,GERD,heart rate variability connect as they all seem to be involved with Sleep Apnea?????

My initial hazy guess is that my mouth topography is unusual. Dentists always comment on my narrow jaw. So some-how my mouth is blocking my breathing at night, voila Sleep Apnea.

And the apnea's cause stress and anxiety and heart rate variability and mess up my heart, pump adrenalin into my system so I live in more stress than most. So this messes up my esophagus and I get hiatal hernia's and GERD and all that. Huhhh!!!!

And because I am in a state of stress, I get ADD like behavior, need to be in a calm environment and don't do too well relating to people directly because I am all stressed out. Huhhh !!!!

Excuse my rambling, I am in a state of shock finding out that Heart Rate Variability is connected with Sleep Apnea !!!!!!

Comments and suggestions welcomed but please no personal attacks.

John M

[rhowald]

I voted yes, but wasn't on any medication.

My doctor originally was discussing depression with me in one session and we were working on other health issues at the time. The irritability, tiredness, poor memory all of it seemed to link.

Then at my next checkup we discussed again and my doc now said that it could be OSA and sent me for a sleep trial. Results showed that indeed was an issue.

After first few nights now see that most of the initial symptoms have lessened.

Rob

[christinequilts]

So how do depression,GERD,heart rate variability connect as they all seem to be involved with Sleep Apnea?????

John- I know it gets overwhelming at times with medical problems trying to find the root cause of a collection of problems or symptoms. But sometimes you have to step back and remember correlation doesn't equal causation. Just because certain condition tend to happen together doesn't mean one causes the other. I remember the example given in my undergrad research methods of more ice cream is sold in the summer and more houses are broken into also. One could incorrectly jump to the conclusion that ice cream sales lead to higher theft rates, and we've all seen reporters make unfounded conclusions like that from a couple line in a research abstract. What else happens in the summer time? Its hotter weather, when we're more likely to eat ice cream and leave windows open, making it easier for theft to occur. But you could have the odd ball neighborhood where the ice cream truck driver is scoping out the territory by day & moonlighting as a cat burglar at night

Definitely get all the problems under control the best you can, especially anything that is treatable like OSA, GERD. I know with GERD, I've seen studies that go both ways- were it causes or makes OSA worse or where OSA causes or make GERD worse. I have CSA (Central Sleep Apnea) and I don't why and I've never found anything to support it, but when my allergies (primarily food) are less controlled, my central apneas increase. I guess sometimes it comes down to being human & being unique!

[jennmary]

I was diagnosed with serious depression when I was 14. Was on meds for it on and off ever since. 6 months ago dr started thinking I was maybe bipolar. That was about the same time I had maxed out on yet another anti depressant. So I stopped the meds.....they had never helped anyway. I have still not seen a difference between being on the meds or off...I feel the same.
I was only 125lbs until I had my daughter 2 years ago. I believe this is part of why I was misdiagnosed. Most people seem to think you have to be obese to have OSA. I have snored since I was a child and as far back as 8-10 my mother remembers me waking up gasping for breath. She just always thought it was asthma related.
I am hoping that CPAP can make the difference that the anti depressants didn't. I know that after my sleep study I felt better than I could remember feeling in years. I started CPAP last night....we will see how it goes.
My fear is that all those years of meds starting at such a young age may have permanently messed up the chemical balance in my brain. Guess I will just have to wait and see.

[dogslife]

I thankfully have a great pcp that listens to me and sends me to any specialest he thinks can help me. He sent me to a sleep clinic and they got it right the first time! They didn't spend alot of time trying to decede what to do. with in 2 weeks I had my sleep study test and results and machine and enjoying a good night sleep for the first time in a long time for both me and my husband. I owe my husband alot for being persistant in making me go and talk to my pcp. and I owe my pcp just as much for listening to me and getting me into such a great sleep clinic and staff!!!

After going back for my 2 month check-up they noticed I still wasn't right so they set me up for another test. after that I found out I also had; hyper somonlessness, and narclipsy. So I am now under strick care from the clinic and getting good sleep once again!

They have taken the time to teach me what is wrong with me and how to live with it. No one could ask for anything better than that!

[seamonkey21]

i feel the same way...

My fear is that all those years of meds starting at such a young age may have permanently messed up the chemical balance in my brain. Guess I will just have to wait and see.

[frete50]

No was not diagnosed with depression. Like Jasper told my doctor about being tired during the day and dozing off at work. She immediately scheduled a sleep study.

Becky

[John 32]

My vote, with no doubt, is some doctors are morons.

And I'm not even a compliant yet. I was diagnosed severe osa at the end of las year.

Before that I was only judged by my psychiatrists about my deppression and eternal tiredness, making me feel that I was the one causing all that to myself.

By almost an accident I had my sleep study done, never expecting it would turn out to show sleep apnea. I can't believe I was happy that day, relieved at last from thinking it was anly a psychological problem. I did not know then apnea was such a pain in the ass desease.

I had gotten to the point of having horrible nightmares, besides the fact of sleeping a lot but feeling I did not rest, anxiety and even being OCD. Now I know you can´t be yourself in your brain when you don´t sleep well.

Before the CPAP therapy in which I'm now for two months, I was talked by doctors into getting the pillar procedure and the radiofrequency UPPP done. It turns out these don´t work with severe apnea like mine. They just wanted to sell me those surgeries. Fortunately I have found new, better, honest doctors now.

But now I have to deal with the fact of not knowing my air preassure yet (I'm waiting for my last titration results in 2 weeks, using an auto PAP now), mouth leaks, therefore not having found my right mask yet, suffering from aerophagia now and then, and still feeling like crap.

But my point is (sorry for ranting), if I hadn't followed my instincts and change doctors more than one time, I don't wanna think how I would be now. At least I know what physical illness might have caused all this, even if after treating my apnea I still don't get better soon.

I feel somedoctors don´t like to feel like patients know more than they know, or when a case is a little or too hard to solve for them. Either they act like they are strong and don't care as a way of dealing with it, or they just don't care. But it's like they can't be strong and care at the same time. And that is without mentioning the dishonest ones.

I have to say finally that I've also found some doctors that have been like angels to me.

Thanks to those who stuck with this long, bitter message and understood.

John.

[jennmary]

I cried tears of joy the day they told me I had severe OSA. I remember realizing that this meant I wasnt crazy and this wasnt my fault. My PCP is GREAT. I only wish I had told him about certian things earlier. I went to a psychiatrist for all of what I thought were "mental health" issues. I never told my PCP about the late night gasping for breath....because I thought it was from my asthma. The day I told my dr about that and the snoring he refered me out for a sleep study. I take part of the blame for not letting my dr in on things that I really didnt think were important. However the shrink I was seeing is an idiot. My condition deteriorated to a point where he should have realized that something might be wrong physically.

[SleepGuy]

Doctors are just now figuring out that untreated sleep apnea is the root cause of many co-morbid conditions. The causal connections arise from the fact that sleep apnea is more than a sleep disorder. Oxygen deprivation causes all kinds of harm to the body--dr bandage taught me that there's no stronger signal to the body than lack of oxygen to the brain. When that happens, all heck breaks loose--panic hormones, shunting blood off to the rest of the body, etc.

I ran across a rather technical discussion from a doctor of how untreated sleep apnea actually causes diabetes and other conditions primarily because nighttime oxygen deprivation seriously interferes with the normal processing of blood glucose and normal hormonal processes. Unfortunately, once diabetes starts, it is irreversible!

Here's a link to the article: http://tinyurl.com/2yse7k

Here's an excerpt:

"Sleep debt strongly affects glucose utilization as well as circadian cycles of thyrotropin, cortisol, growth hormone, and other physiological variables. Sleep debt alone is reported to result in impaired glucose effectiveness similar to that found in non-insulin-dependent diabetics. Severe OSA significantly influences plasma insulin and glycemia and may increase the risk of diabetes independently of obesity."

"Insulin resistance is found in both obese and non-obese OSA patients. Blood pressure and fasting insulin correlate closely with both BMI and the severity of OSA. Thus, both the sleep debt and the sympathetic activation that accompany OSA may speed the deterioration of glucose tolerance. Insulin resistance and hyperinsulinemia lead to further sympathetic activation, thus completing the circle of obesity, diabetes, hypertension, and the related metabolic abnormalities.

"Clearly, it is important to manage all the risk factors for diabetes and hypertension. Patients with diabetes, obesity, and hypertension have about a 70% chance of having significant OSA. Thus,OSA must be included in the differential diagnosis for hypertension. Treatment of OSA in the obese, diabetics, and hypertensives may improve insulin responsiveness (32%), reduce blood pressure, and normalize the abnormal growth hormone cycle – and may possibly improve the impaired lipid metabolism seen in OSA. Patients with hypertension and diabetes should be asked specific questions that can reveal undiagnosed OSA. A positive answer to the following two questions provides a 90% predictability for identifying a sleep disorder:

• Do you snore?
• Have you ever been told that you stop breathing during sleep?

"Physicians who ask these questions can expect an eightfold increase in OSA patients in their office. After treatment of OSA, they can also expect improvement in the management of both hypertension and diabetes."

Recent articles in Chest and Cardio Thoracic Journals state that after the onset of insulin resistance, little can be done to reverse it. Thus, xPAP therapy may save you and your body from the ravages of diabetes!

[socknitster]

Unfortunately for me, I inherited it and it's resistant to anti-depressants. The depression led me me gaining a LOT of weight (and maybe the apnea too).


Did you know that there is a blood test (don't know how widely available it is because I saw it on tv) that can determine which antidepressant will work best for you? I would see a psych and ask about it. It would save a lot of trial and error. Of course, I don't know if insurance would cover it, maybe your doc would be willing to do "creative insurance coding."

Jen