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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
micpenn
 
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CPAP causing daytime anxiety and depression?

Postby micpenn on Sun Sep 22, 2013 12:29 am

Hello,
I am wondering if anyone out there has a similar story as mine? I was diagnosed with sleep apnea and put on CPAP therapy and after some adjustment to the pressure I was put on a 11 pressure setting. Everything seemed to work out good especially that my wife was no longer pissed at my loud snoring. Then I started to notice the dreaming.......I mean lots of them and way more than was normal for me......no nightmares just many dreams. I asked my doctor and she said that was normal with CPAP and in time it would lessen.
Ok, so far, but after a few months on CPAP ( and I mean religiously, I really was committed ) I started to notice an old nemesis creeping back. You see for most of my life I have suffered from episodic depression and anxiety ( episodic meaning it would cycle every five years or so) with relative normal periods in between. That is until my last major episode of over 15 years ago when I was advised that my type of depression means that I must be on medication ( paxil ) for the rest of my life. Like I say for so many years I have been relatively good.......
That is until CPAP ! So getting back to the story I started noticing this anxiety and depression coming back; which if any one has been a sufferer of this would quite agree with me that you know......I mean just know.......when you're not right. And a true sufferer will do anything to avoid that "black abyss" which I speak of. However, I kept at the CPAP not really making any connection and things were starting to get to the point where my business and family life were affected. I started to contemplate going back to my doctor and see about changing my meds, something I was loath to do since the paxil was working for so long. Then one day I was wondering the net and happened up a post with someone ( not sure if it was this forum ) with very similar situation that made the connection with anxiety caused by CPAP.
Well, truth be told that's when a light went off in my head and I thought to myself to do a trial and stop the CPAP. When I did I noticed myself going back to normal and feeling fine again. It's been over a month since stopping and my wife is pissed and scared because she figures it's dangerous in a person with sleep apnea; in which I always reply that I would rather die in my sleep than by suicide! ( again if you haven't suffered from major depression you will think I am crazy, and if you have, you will most probably agree with me!)
The question is: if there's anyone out there has had the same problem and if they were able to resolve the issue somehow? I would really like to go back on CPAP but not at that cost and am considering another kick at it, to see if it happens again. Above that I thinking it may have something to do with the increase in REM sleep I experienced with the CPAP that may be some how linked. After all it does (CPAP) change your sleep patterns and for most for the better; maybe for people like me for the worse. Any ideas would be greatly appreciated. Thanks.

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Re: CPAP causing daytime anxiety and depression?

Postby kaiasgram on Sun Sep 22, 2013 1:22 am

Hello micpenn -- It sounds like it's going to take some time to get all this sorted out. I don't have exactly the same situation as what you're describing, but my quality of sleep since starting on PAP a year ago has changed and not all happy changes. I'm breathing at night and no longer starving my brain of oxygen. That's the good part. But my sleep on PAP is not restorative for reasons that have never been clearly identified (or resolved) by my doctors (longer story, not relevant to yours) and the lack of good quality sleep affects every aspect of my life.

You said that in the beginning "everything seemed to work out good" -- do you mean that you were feeling better, or that your apnea was well controlled, or both? Does your cpap machine provide you with treatment data and if so, have there been changes in your AHI over time? If you're going to give the machine another try (and I definitely think that's a good idea), enter your equipment in your posts like most of us have done -- it's essential if people are going to give you suggestions about things to try with your machine, mask, etc. I wondered if the return of your mood symptoms could have had anything to do with your therapy becoming less effective for some reason, maybe adjustments to pressure needed, those sorts of things. It seems important to get a good handle on what exactly is/was happening with your PAP therapy.

Another thought -- getting on cpap therapy does change your sleep architecture in most cases (people commonly report more dreaming). I'm wondering if there simply is a difference in how Paxil behaves in your system when you're on cpap and when you're off it. We would hope the difference would be a positive one when you're on cpap and breathing well, but sometimes people have paradoxical responses to medications in different situations.

Another thought -- I'm in the mental health profession and I know (and you may already know too) that sometimes, for some people, the SSRI's (Paxil is an SSRI) start to lose their effectiveness with long term use -- sort of a "poop out" effect. If that's the case, there are ways to address this. Any chance that could also be part of the story of your symptoms starting up again?

There are a lot of variables in the mix and I suspect it will take a while to get it sorted out through trial and error. BTW, did you make any other changes at the time you went off your cpap (medication, food, any lifestyle changes)?

I understand your wife's concern about you discontinuing cpap. But I also understand it's hard to go back on it when you feel significantly better without it. I'm thinking, though, that the relief or improvements you're experiencing right now could be short-lived. I'm assuming there's a reason you got tested and put on cpap in the first place, and I would expect a return of whatever those symptoms were if you stay off the machine for too long.

Keep us posted as your story is going to help others, and hopefully people here will be able to help you along the way.

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Re: CPAP causing daytime anxiety and depression?

Postby kteague on Sun Sep 22, 2013 1:47 am

Hello and welcome. Yes, we do know ourselves best, so if you were feeling something isn't right, it's good that you are in tune with that and desire to be preventative. I have read others on here who have had to change their medication dosage once they got settled in on CPAP. Something about the well rested brain has different needs than the sleep deprived brain. I do understand your wife's concern about you not having a needed treatment - the CPAP. I'm wondering what machine you've been using. If it happens to be one that reports data, the crew here could instruct you how to access the data and maybe there would be a clue if the therapy wasn't actually optimal and could account for some of your symptoms. I can't say I have answers for you - I've not used that medication. nor have I in recent years had the problems you're having. I just want to encourage you to continue to seek solutions. I'm expecting you won't have to give up your emotional well being or your CPAP, but as was already said, it might be a process here. Hang in there, and let us know about the type of machine you have.

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Re: CPAP causing daytime anxiety and depression?

Postby Julie on Sun Sep 22, 2013 4:22 am

And I'm wondering about two separate, if parallel conditions being confused into one - e.g. episodes of depression usually have a timeline built in of a few weeks or months, and then get better (if only to worsen again at some time in the future). And Cpap can have a similar one, completely independent of depression - which, however, can certainly be a result of OSA. Beginning Cpap often makes people feel terrific, but after a few weeks the honeymoon period ends and they feel worse again until eventually dealing with all the glitches of masks, pressure setting, etc. So I'm wondering if your recent depression timeline has incidentally overlapped with your Cpap experience and you're blaming one on the other. I'm not sure if you can sort out though, which is which, and when. Just something to think about.

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Re: CPAP causing daytime anxiety and depression?

Postby oak on Sun Sep 22, 2013 7:44 am

Hi micpen, I have experienced a cycling of depression and anxiety over many years as you have. I am relatively new to CPAP (July), and had very little REM sleep prior to CPAP.

Here are my thoughts: 1) it wouldn't be unusual at all to have your anti-depressant become less effective. As someone here indicated, it may be a coincidence along with your use of CPAP. 2) From what I have read and experienced, CPAP finally allows actual restful sleep and restful sleep allows dreams, ie consolidation of daytime issues and events. This allows the unconscious mind to process many things that aren't able to be resolved with therapy, lifestyle changes, and medication alone.

Is it possible that your brain/mind (both your conscious and unconscious) could finally "attend" (with REM sleep and CPAP) to some things that were not resolved for you, and in the process, have caused increased anxiety?

Personally, I think that to sort this out, you will benefit from the help of your doc (hopefully a sleep doc or a psychiatrist) and a therapist, if you have one.

Good luck and do let us know how it goes. There are others here who could benefit from you sharing your journey. oak

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Re: CPAP causing daytime anxiety and depression?

Postby BlackSpinner on Sun Sep 22, 2013 9:10 am

First - stopping cpap therapy is NOT the answer. The rest of your body depends on your O2 level and the need for sleep. Felling not depressed doesn't help if you have a stroke or heart attack or "die quietly in their sleep"

What machine do you have? Does it give data? If so what does your data say? How old is your mask? Does it need replacing?

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Re: CPAP causing daytime anxiety and depression?

Postby SteveGold on Sun Sep 22, 2013 9:11 am

I had the same experience.

I'd had depression on-and-off for years that dropped off as my sleep apnea developed. When I started CPAP, I started dreaming a lot more, and became crippingly depressed for about two months. I stayed with the CPAP because I felt better in other ways - I felt more rested, and clearer, and more mentally agile.

After a couple of months the depression lifted, and hasn't been an issue since.

I don't claim to understand it, but I do have an hypothesis. I was getting deep sleep for the first time in years. That's going to change your brain chemistry. I also think I was running on pure adrenalin for years - it was the only thing getting me through the day. Once I could sleep properly, and deeply, I no longer needed to be "geared up" all the time to function. So I dropped a few gears, which led to depression until things balanced out.

But who knows. My sense from reading these boards is that CPAP does take a few months at least to "balance out," in all sorts of ways.

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Re: CPAP causing daytime anxiety and depression?

Postby micpenn on Sun Sep 22, 2013 2:01 pm

Alright,
First of all, thank you so much for so many reply s!
I have updated my account to include my equipment.
There are a few points I need to clarify: When I refer to my past history of episodic depression/anxiety, keep in mind it was the distant past. As far as I can tell it started when I was 12 years old and used to cycle for about every five or six years. While I make pains to link the two - depression and anxiety - it usually alternated between primarily depression in one episode and primarily anxiety (panic attacks and all that entails) in the next. For the most part in my early years it went untreated; it would abate by itself, but leaving a lot of wreckage behind ( along with some really good insights into empathy, compassion, the human condition, and self awareness.) The major point being that the cycling was in the past........I have been on Paxil and largely symptom free some 15 years before CPAP. Also, without getting into a lot of details, all indicators pointed too a biological/brain chemistry causation.

True, sometimes a particular med can stop being affective, but that doesn't explain how my symptoms went away after stopping CPAP.

Furthermore, much like the first commentator Kaisagram, while I was on CPAP I didn't notice this "overwhelming refreshing" awaking in the morning like most do. At first it could be said to be "like yea alright, but nothing to write home about" and then later just before I discontinued, my mornings were filled with fears and anxiety like some large hammer over my head ready to strike, which would only abate the closer I got to nighttime .........something that was very much apart of my symptoms so many years ago.

I realize that sleep apnea is a dangerous thing and I would like to get back on CPAP but not at the expense of my old nemesis coming back to haunt me. I cannot state that enough. It would be hard for a non sufferer to understand this.......or possibly even a mild sufferer. To give an example an elderly neighbour who had suffered the same type of depression throughout her life and was also battling cancer commented to me " oh the cancer doesn't bother or scare me, but the damn depression, oh the damn depression" and I knew exactly what she meant. The reason I have posted on this forum is that maybe, just maybe, I might get some insight into how I can have "my cake and eat it too".

I also understand that my case is probably atypical and not simple. I have little confidence in my sleep doctor and the sleep clinic that handled me. At the begging there was a lot of BS going on without getting into a lot of details. It seemed between them and the seller of the equipment they were only looking out to grind out as many dollars as they could. As far as the machine goes I don't even know if it can collect the data some of you mentioned, and if so, was I told how to even get at it. Furthermore, I was started off at too low of a setting ( waking up with a sensation of not being able to breath, ironically something I have never experienced without the machine!) in which I was forbidden from changing ( wasn't told how too) the air setting without having to wait for another sleep session and another appointment with the doctor. Well, I went online and learned how to adjust the thing myself and here is the great part........they informed me two months later what my ideal setting was when I had fooled around myself and arrived at just this setting and was at it for the two months before they told me!

Oh and I forgot, my case gets even more atypical, in that I have fallen into a weird sleep pattern these last few years. Because I own my own business my work hours are a bit more flexible than most. I usually awake at 9 or 930am and see to my business appointments and such till around five or six pm. Then I sleep for an hour or two, wake up and do my paper work and such then maybe go to bed around 2am or so. I know I am going to get a lotta flack for this, but it really has suited me fine, and I find myself quite a bit more productive under this routine. They have since found precedent in past for this type of pattern ( two sleep cycles ) being the normal one and not what we now consider to be normal. Winston Churchill had this sleep habit also, and he seemed to manage all his many responsibilities during the war. (and he also suffered from periodic depression)

Above all thanks for your comments they are greatly appreciated!

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Re: CPAP causing daytime anxiety and depression?

Postby Julie on Sun Sep 22, 2013 2:16 pm

Hi - there was a long thread about 'interrupted' sleep patterns a few months ago, and how the way we sleep now is not natural for many people. Apparently very long ago people routinely slept for a few hours, then got up and did... whatever, until they went back to sleep for another while. So what you're doing, if it works for you, is not necessarily bad at all as long as it's reasonably consistent, and you get enough hours to make it work for you.

Thanks for the update on your depression (sounds like it even could have been bipolar when you were young) and your Paxil, etc. I would (if I were you) want to talk to a psychiatrist now though to sort out where Paxil fits with Cpap because apart from whatever obvious 'side effects' might or might not interfere, I wonder if it's now (that you know about OSA) the most appropriate and/or beneficial thing to be on if you need Cpap. There are alternatives to Cpap that work for some people, though I'd be very leery of surgery as the majority of it (done by ENT's) generally reverts after a year to where you were previously, and sometimes can even make things worse in terms of being able to use Cpap effectively. Dentists, with agendas advocating 'devices', do have some answers some of the time for some people, but a lot of those, while they relieve snoring, etc., may not always 'treat' OSA properly.

So I think you have more research to do... you do need to find out if a) you really have OSA and it's not 'just' positional, but theoretically needs Cpap, and therefore what to do about it that won't make you feel crappy afterward, and b) what's going on that makes you feel that way, and what else you could try to fix the OSA if Cpap, even after good tries with various equipment, makes you feel worse.

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Re: CPAP causing daytime anxiety and depression?

Postby oak on Sun Sep 22, 2013 6:01 pm

I realize that sleep apnea is a dangerous thing and I would like to get back on CPAP but not at the expense of my old nemesis coming back to haunt me. I cannot state that enough. It would be hard for a non sufferer to understand this.......or possibly even a mild sufferer.


I do understand. I do also think that to do justice to CPAP, however,which could save your life, that it is important to look at/unravel whether you are tangling something (CPAP) with depression and anxiety that perhaps shouldn't be "tangled," especially since you experienced it several times in your life before CPAP. A therapist could help you explore this. Yes, therapists can even help if your depression and anxiety are "chemical."(Just so you know, I didn't have mild depression and anxiety. I had/have major depression and anxiety, and I worked in rehabilitation for 20 years, so I have knowledge of the topic both as a consumer and as a professional).

You mention some of your frustrations with the doctor and sleep center you dealt with. You are not alone. In fact, the majority of us have experienced something similar. Unfortunately there are many docs dabbling in sleep medicine who shouldn't be, and this area of medicine is fragmented as hell. Time to get a new doc if there are others within driving distance. You can find a board certified sleep medicine specialist here:

http://www.certificationmatters.org/

I wish you the best in your journey and keep posting.

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Re: CPAP causing daytime anxiety and depression?

Postby SleepingUgly on Sun Sep 22, 2013 7:10 pm

It's understandable that you don't want to go down that depression/anxiety road again, and I disagree with those who think OSA is more life threatening than debilitating depression. My thoughts are that you (1) need data on how your therapy is going, and (2) would benefit from seeing a sleep doc who is also a psychiatrist, as they will know much more about the meds you are on and how to manage the depression, anxiety, and sleep.
Never put your fate entirely in the hands of someone who cares less about it than you do. --Sleeping Ugly

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Re: CPAP causing daytime anxiety and depression?

Postby micpenn on Wed Apr 02, 2014 10:15 pm

Tan Tom,
I have just received notification of you post by e-mail, which has been dormant for a number of months now.
Wow! our cases couldn't be more similar! I too have been on Paxil long term now; my problems also started in childhood; and ditto with the cpap problem, and also the Paxil still works for me, but like you not, quite as effective as it was when I was first on it. Some of the issue with the Paxil I can handle ( and don't squawk about) because nothing has been no where near as close to any "full blown" episode since I have been on it, and I am sure you know where I am coming from on this having been a sufferer of the dreaded "dark disease". Since my last posts back in Sept I have went back on CPAP, which has been 5 month's now. I have a a few observations on it:
While I haven't gone down too bad like when I first started before my Sept posts it isn't all hunky dory either. It just never seems like I wake up so overwhelmingly refreshed and rested like so many other CPAP patients have reported. It takes me much longer to actually wake up in the morning before I can get going. Then the dreams! Non stop dreaming! I can't say that anyone can get a good nights sleep (though I am no sleep expert and I could be wrong) with all this crazy crazy dreaming.....running for you life, swimming, driving, and just about any crazy theme played out in your sleep cannot be all that rest full ( again I could be wrong .) In fact I have heard that for people with our sort of condition, excessive dreaming isn't all that good, as most of the anti-depressants act to suppress dreaming. That being said, I haven't been as bad with the CPAP since restarting but there's a big proviso to this. I haven't been too stressed either. Back when I first started I was under stress running my construction business and since restarting the CPAP it's been the dead season of winter so not a real test. That will come now with the onset of the busy spring and summer season. So the jury's still out. I have told some of my concerns to the original sleep clinic doctor that first diagnosed me but that didn't get me too far and it seemed to me I need someone who has a little more experience with CPAP and people on anti-depressants. I mentioned all this with my family doctor and she has given me the name of another sleep doctor that may be more in tune with my unique problem, but I haven't made an appointment yet.
So I really don't know where I am going to end up with all this, as I said the jury's still out. I would like to keep this post going, maybe these new posts will bring the issue back to the forefront and we can see if there are others out there with similar problems. I would like to ask you though if - since being on Paxil so long like me - if you know of any internet forum specific to Paxil users? aside from the CPAP problems, I have a number of issues that may or not relate to the long term Paxil use and would like some feedback on them. Never the less, I would love to hear of anymore of your experiences either with the CPAP or long term use of Paxil. I do know one thing though......I will risk nothing to go back to the "big dark hole" if you know what I mean.

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Re: CPAP causing daytime anxiety and depression?

Postby TanTom on Thu Apr 03, 2014 11:28 am

I have also heard that excessive dreaming can be problematic for anxiety conditions. In fact, I read that on another cpap site but haven't been able to go back and find the link since coming across your story. Again, I of course can't be sure that cpap has led to the recent aggravation of my condition but the timing is very suspicious. And again, I'm not ready to give up yet. I still hope I can find some kind of equilibrium where I can get the benefits of limiting OSA with cpap while also continuing to manage anxiety and depression. So far I'm getting by but I have had some pretty alarming episodes. Nothing like what I was dealing with when I first sought help and got on paxil 20 years ago (sleeping 0-4 hours per night for weeks at a time and barely functioning) but still enough to be concerning.
Paxil has been a life saver to me. It allowed me to go from thinking I wouldn't even have much of a life to relative success in my profession and a beautiful family. But the thought that it could poop out completely or that something else could happen to put me back in, as you say, a "dark" place, is always in the back of my mind and so these latest flare ups that have coincided with the introduction of cpap have been concerning. Still, I long ago decided I had to live my life forward, not dwell on negative possibilities and just deal with any episodes (and as I mentioned I've had a few even before cpap that I dealt with by adjusting lifestyle and diet) the best I can if and when they do arise.
Regarding your question about forums for talking about paxil, I'm not aware of any in particular. I have poked around in the past but have not found anything too enlightening. It's common knowledge that it can lose its effectiveness but I've yet to hear of a viable substitute.
My cpap experience also tracks yours fairly closely in that it hasn't worked any miracles for me but the quality of my sleep is better (even if I get less of it at times with the anxiety ratcheting up).
At any rate, thanks for bringing this issue up and let's do keep each other updated of any related developments or new findings that we become aware of.

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Re: CPAP causing daytime anxiety and depression?

Postby micpenn on Thu Apr 03, 2014 10:35 pm

Tan Tom, again thanks for your reply. Your post brought up so much that I have forgotten; it brought back some memories. Again I marvel how similar our cases are. I, like you, thought I would have no future, let alone have a successful business and a family life. That's why I get a bit upset with people who ram down antidepressants; they don't know how debilitating true clinical depression/anxiety is, not to mention the suffering. Paxil has saved me from those grinding episodes. I fear that some day it may loose its effectiveness, while I suspect that it has to some degree, nothing truly to write home about, yet, anyway. As for my problem with CPAP, many on this forum thought that I was misreading the cause of my sudden jump in anxiety to CPAP. However, the coincidence was too hard to discount. Indeed, back when I ceased CPAP for two months the symptoms went away. Then the good people on this forum convinced me to give it another kick at the can. So here I am back on it for some number of months with (so far) no repeat of the symptoms. As I said the jury's still out, but if it starts up again I may discontinue CPAP, and try to find a more knowledgeable doctor; more knowledgeable about CPAP and those suffering from depression/anxiety, and that are on antidepressants. As you alluded to, I suspect our sleep patterns are different than most, after all that's what may have got us into trouble in the first place. So like a drug interaction CPAP and antidepressants may be contraindicated. Just speculation on my part......but are there any research doctors out there reading this post????? Maybe something that should be looked into. As far as the insomnia that is the other horrible thing I remember. My problem was not so much falling to sleep, but the constant wakings, waking with horrible thoughts and dreams. Not having a decent restful sleep for months. Anyway, when I went off it (CPAP) my wife was really concerned and said to me "you could stop breathing and die in your sleep" and I replied better that then............well, some things are better left unsaid, if you know what I mean.
I understand you are still on CPAP as I am, so maybe things will even out in time, as many have said on this forum. Keep me posted on how your battle goes and I will inform you of any new developments on my part. Glad to know there are others out there with the same problem. Makes you feel a bit better, and not so alone.

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Re: CPAP causing daytime anxiety and depression?

Postby jaye8898 on Thu Apr 03, 2014 10:51 pm

TanTom wrote:I have also heard that excessive dreaming can be problematic for anxiety conditions. In fact, I read that on another cpap site but haven't been able to go back and find the link since coming across your story. Again, I of course can't be sure that cpap has led to the recent aggravation of my condition but the timing is very suspicious. And again, I'm not ready to give up yet. I still hope I can find some kind of equilibrium where I can get the benefits of limiting OSA with cpap while also continuing to manage anxiety and depression. So far I'm getting by but I have had some pretty alarming episodes. Nothing like what I was dealing with when I first sought help and got on paxil 20 years ago (sleeping 0-4 hours per night for weeks at a time and barely functioning) but still enough to be concerning.
Paxil has been a life saver to me. It allowed me to go from thinking I wouldn't even have much of a life to relative success in my profession and a beautiful family. But the thought that it could poop out completely or that something else could happen to put me back in, as you say, a "dark" place, is always in the back of my mind and so these latest flare ups that have coincided with the introduction of cpap have been concerning. Still, I long ago decided I had to live my life forward, not dwell on negative possibilities and just deal with any episodes (and as I mentioned I've had a few even before cpap that I dealt with by adjusting lifestyle and diet) the best I can if and when they do arise.
Regarding your question about forums for talking about paxil, I'm not aware of any in particular. I have poked around in the past but have not found anything too enlightening. It's common knowledge that it can lose its effectiveness but I've yet to hear of a viable substitute.
My cpap experience also tracks yours fairly closely in that it hasn't worked any miracles for me but the quality of my sleep is better (even if I get less of it at times with the anxiety ratcheting up).
At any rate, thanks for bringing this issue up and let's do keep each other updated of any related developments or new findings that we become aware of.


I too suffer with depression and have most of my life. It can be quite debilitating. I do a lot of research, see a therapist weekly, a psychiatrist on a monthly basis, and take medication. Inevitably, the medication (including Paxil) stops working and my psychiatrist and I go back to work trying to find the "right" mix. Treating my OSA is just one of the ways I'm trying to help myself.

I found this article a while back I thought you might find interesting:

http://www.why-we-dream.com/depression.htm

As someone who has lived in that "dark world" many times, I sympathize and wish you the best!

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