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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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49er
 
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Re: CPAP causing daytime anxiety and depression?

Postby 49er on Fri Apr 04, 2014 3:11 am

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.


Try these sites:

http://survivingantidepressants.org/index.php?/index

http://www.paxilprogress.org/forums/

_________________
Mask: SleepWeaver Elan™ Soft Cloth Nasal CPAP Mask - Starter Kit
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
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The goal is one: saving lives. This is the time to show our "true colors". We cannot be distracted by anything else.

Bran1
 

Re: CPAP causing daytime anxiety and depression?

Postby Bran1 on Sun Apr 27, 2014 12:26 pm

Read post with great interest. I started CPAP Approx 3.5 years ago no previous anxiety issues, aged 40, within 4-5 months of using out of the blue had my first ever panic attack. 3 years on still suffering ongoing anxiety and have always at the back of my mind been curious of a link. Have had jaw,TMJ issues sore neck etc ever since. I have only recently started to seriously link the issues. Never thought of the deep sleep dream being a factor but sounds like it makes some sense. I have dwelled more on the feeling the pressure of the air has had. Pressure on jaw keeping mouth shut, feeling of not relaxing properly and different style of breathing. Whilst I certainly have a deeper better sleep I also wake feeling body on edge. So I wonder whether my body seems to be aware of this unusual air pressure that causes it to be on a high state of alert. Have now been off CPAP for 3 days and whilst I know it is very early days do not feel the same on edge way. Still not perfect but I guess I have 3 yeArs of learnt behaviour to overcome. Like others feel it is too coincidental for there not to be some link, just hard to know what it is. I will watch with interest developments.

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Todzo
 
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Re: CPAP causing daytime anxiety and depression?

Postby Todzo on Sun Apr 27, 2014 2:17 pm

I am not surprised to hear that you found CPAP to change your brain function. First of all Obstructive Sleep Apnea (OSA) occurs during the maintenance time for the brain and tends to upset it. So if you fix OSA that alone will begin to change brain function and upset the equilibrium which has been found with your brain, life, and the antidepressant.

But during a stressful time in your life CPAP quickly did more harm that good. I have a possible explanation.

The anatomic factor that CPAP is designed to fix is the critical closing pressure of the airway. The idea is that it simply does not let the air inside the airway reach that pressure. But there are nonanatomic factors which also contribute to sleep apnea[1,2]. Lets look at two of them:

High respiratory control loop gain. To illustrate how a control loop works consider getting the water temperature comfortable in the process of taking a shower. To make this happen I hold my hand under the tap and adjust the lever in the direction of hot or cold depending upon what my hand felt for temperature. Now if the hot water were say 50 degrees hotter than normal imagine how it would be hard for me to find the comfort point. First too hot, then only a little change results in too cold, then too hot again. With the “gain” higher it is harder to find a stable point. So it is with breathing when the gain is too high. The times of high breathing can result in arousals. The times when breathing is too little can be hypopneas or apneas. Technically they are hypocapnic central apneas or hypopneas.

So looking back at what you described it may have been that the PLUS respiratory control loop gain factors of CPAP PRESSURE + LIFE STRESS = unstable breathing with arousals and circulation and metabolism changes especially in the brain.. This may have also resulted in long term facilitated hyperventilation. I have seen life stress result in hyperventilation during the daytime. There is no doubt in my mind that life stress is a major player in respiratory gain night and day.

Then there is the arousal threshold. Often arousals in sleep apnea are known as respiratory effort related arousals. In the case of an obstructive apnea it is true that the respiratory effort, vain as it may be, leads to the arousal. But if the threshold is low enough a minor change in breathing effort can trigger arousal.

I think that both arousal threshold and loop gain could be related to a too low or too high vitamin D3 level. Where I live we get no UVB from the Sun from about August to April. Vitamin D levels drop all that time.

Those who are working with the D3 hormone (A.K.A. Vitamin D3) (e.g. Dr. Stasha Gominak, Michael F. Holick, Ph.D., M.D., Vitamin D Council) seem to be finding that the very low side of the “normal” range of 30-100 ng/L produces a range of symptoms including OSA, pain, and infection. All believe that a level lower than 50 ng/mL is not good and Dr. Stasha Gominak recommends 60-80 ng/mL for good health.

It would probably be wise to check your vitamin D3 levels. See “The Vitamin D Council” for assay details.

For arousal threshold the best thing for me is a good long walk during the day. I walk regularly so enstead of my average 8,000 or so steps I would walk say 14,000 steps. It is enough for me to notice feeling tired at the end of the day, makes it easier for me to fall asleep, and since much of it is up hill in my little city I believe the respiratory control system also gets a good workout and so breathing seems to be more stable as well.

I believe that all with OSA should be assigned a dietitian and personal trainer for three years.

But it may well be that your arousal threshold and respiratory control system gain issues cannot be controlled with good effort to control life stress, vitamin D3 levels, moving well and eating well. It this occurs I would recommend that you talk with your doctor about using EERS[3] or even possibly dynamic CO2 therapy[4]. I mention to a member here that I thought they were headed toward using a new generation ASV PAP to deal with the ventilatory instability I believed they were dealing with. Thier response was that they believed they could not possibly deal with the constant pressure changes from an ASV. EERS is passive and I have used this myself to help smooth out the breathing issues during times of high stress in my life. What can I say. It works for me.



[1] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[2] Sairam Parthasarathy M.D., Emergence of Obstructive Sleep Apnea Phenotyping. From Weak to Strong! American Journal of Respitory and Critical Care Medicine VOL 188 2013
-- critical closing pressure [Pcrit] - Arousal Threshold - ventilatory control Loop gain - and genioglossal Muscle responsiveness. Pcrit, Loop, Arousal, Muscle (PALM)--

[3]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[4]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721
May any shills trolls sockpuppets or astroturfers at cpaptalk.com be like chaff before the wind!

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49er
 
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Re: CPAP causing daytime anxiety and depression?

Postby 49er on Sun Apr 27, 2014 2:55 pm

Bran1 wrote:Read post with great interest. I started CPAP Approx 3.5 years ago no previous anxiety issues, aged 40, within 4-5 months of using out of the blue had my first ever panic attack. 3 years on still suffering ongoing anxiety and have always at the back of my mind been curious of a link. Have had jaw,TMJ issues sore neck etc ever since. I have only recently started to seriously link the issues. Never thought of the deep sleep dream being a factor but sounds like it makes some sense. I have dwelled more on the feeling the pressure of the air has had. Pressure on jaw keeping mouth shut, feeling of not relaxing properly and different style of breathing. Whilst I certainly have a deeper better sleep I also wake feeling body on edge. So I wonder whether my body seems to be aware of this unusual air pressure that causes it to be on a high state of alert. Have now been off CPAP for 3 days and whilst I know it is very early days do not feel the same on edge way. Still not perfect but I guess I have 3 yeArs of learnt behaviour to overcome. Like others feel it is too coincidental for there not to be some link, just hard to know what it is. I will watch with interest developments.


Bran1,

You might want to start your own thread so this doesn't get lost in the shuffle and fill out your equipment profile so members can better direct their responses to your situation. Perhaps your therapy might not be optimized or there are other medical conditions you are dealing with.

49er

_________________
Mask: SleepWeaver Elan™ Soft Cloth Nasal CPAP Mask - Starter Kit
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Use SleepyHead, Pressure is 13.6/9.6
Carmen Yulín Cruz‏Verified account @CarmenYulinCruz
The goal is one: saving lives. This is the time to show our "true colors". We cannot be distracted by anything else.

ironhands
 
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Re: CPAP causing daytime anxiety and depression?

Postby ironhands on Mon Apr 28, 2014 12:15 pm

Yup. As I've now been dreaming more, I've noticed a little more depression. The CPAP hasn't changed my energy levels, though. Take some l-tryptophan before bed, and in the morning, it'll give you a deeper sleep, and in the day it'll convert to serotonin to stabilize your mood.

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Mrmonkey
 

Re: CPAP causing daytime anxiety and depression?

Postby Mrmonkey on Thu Apr 20, 2017 10:28 pm

Try lowering your pressure. My pressure was at 9.5 I weighed 315lbs. I'm now 270 and was having horrible anxiety episodes every other day. Dropped my pressure to 6.5 and am starting to feel better every day.

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