CPAP causing daytime anxiety and depression?

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

Post by micpenn » 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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kaiasgram
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Re: CPAP causing daytime anxiety and depression?

Post by kaiasgram » 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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kteague
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Re: CPAP causing daytime anxiety and depression?

Post by kteague » 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?

Post by Julie » 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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oak
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Re: CPAP causing daytime anxiety and depression?

Post by oak » 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?

Post by BlackSpinner » 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?

Post by SteveGold » 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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micpenn
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Re: CPAP causing daytime anxiety and depression?

Post by micpenn » 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?

Post by Julie » 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?

Post by oak » 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?

Post by SleepingUgly » 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?

Post by micpenn » Mon Sep 23, 2013 10:38 pm

Wow,
What a incredible community this is! Thanks again for your helpful replys.
Like many of you have mentioned I probably need to go a little further down the road with a doctor. That will probably mean someone (like Julie and SleepingUgly said) that is a bit more versed in Psychiatry as well as sleep apnea. Maybe a more involved sleep study in light of the meds I take, and my history along with REM sleep pattern changes.
Oak, thank so much for your comment, I appreciate your openness. Maybe you can understand I find it hard to even talk about being a depression sufferer ( not nearly as much as before though) you see when it started ( 70's early 80's) things like this were kept quiet. The stigma attached was incredible even to the few family members who saw me going through it advised me to "keep it quiet" or "people will look at you different". Letting it get really bad before seeking treatment was par for the course back then. The younger generation cannot possible begin to understand with all the openness ( and knowledge I guess) about it today. Heck, when I first had the cycle with the panic attacks ( 1977 ) they had no name for it, nor did the doctors have any idea what the heck was going on. The only counseling I got was "that there is nothing wrong with you" and after after having one doctor tell me it was "mental" he referred me to pipe smoking ( I swear he was putting a Sigmund Freud affectation) psychologist about an hour away at a university only to tell me " that you just need too relax" no follow up, that was the end of the treatment. So, when someone is open about it I understand it can take a lotta guts. When I say I " major depression" I don't mean to be disparaging I just want to differentiate between what sometimes passes for depression today......when my sister died when she was only 36 with a six year old daughter I was wrecked, likewise when my mother died, or with the many business setbacks I had Etc......but it was different, much different......you know what I mean. That being said I am open to your idea that I may be "tangling" something here; and some of the "entanglement" may have been the fact that when the problem started with CPAP it was the time when my business is most busy so I could ill afford to be under an additional stress. I am contemplating giving it another trial when my business enters it's normal slow period. About "entanglements" I could go on and on but as you know with that disease there are always "entanglements"; baggage that you pick up along the way. The fear of it is probably the biggest (though cognitive therapy can do a lot in this regard) so maybe you all are right that I have to give it another try. Thanks all for the advice. I still would like if someone out there that has had the same problem to write in. Furthermore I apologize if I turned this thread off a strictly a CPAP issue.

Julie
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Re: CPAP causing daytime anxiety and depression?

Post by Julie » Tue Sep 24, 2013 4:21 am

Nothing to apologize for. There are other people here with side issues, quite a few without OSA themselves, but who have family members struggling with it, or other diagnoses that reference equipment but are otherwise not related, etc.etc. Makes it more interesting for those of us with 'everyday' problems and puts them in perspective. Plus we get to learn so much from you that we otherwise wouldn't!

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Re: CPAP causing daytime anxiety and depression?

Post by somemommy » Wed Sep 25, 2013 8:54 pm

micpenn,

I have stumbled upon this forum searching for information regarding use of Cpap and anxiety. I have been a Zoloft user for year....just started CPAP and wake up feel anxious. Seems to fade as the day wears on, just like you.

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Re: CPAP causing daytime anxiety and depression?

Post by TanTom » Wed Apr 02, 2014 11:36 am

My experience matches yours almost exactly. In fact, I found this thread by googling my situation. I have also used paxil long term (20 years) to treat depression and anxiety that had first manifested in childhood. While paxil has definitely lost some of its effectiveness for me over time, I have been able to compensate by adjusting my lifestyle and diet (e.g. regular exercise, no alcohol, whole foods etc.) and have managed quite well. I have had some flare-ups of anxiety/depression over the years, but most of these have been caused by me trying to go off paxil, while the few other episodes helped guide me toward those lifestyle/diet adjustments. At any rate, I have been on cpap for about 8 months now and have had a number of anxiety/depression flare ups that have been quite intense, and definitely worse then anything I have experienced over the last few years when I was managing well with paxil + diet/lifestyle. The first episode happened about a month after I started cpap and lasted for about a week, and I have had intermittent issues since then, again with greater frequency, duration and intensity than anything I had experienced over the past few years. I have considered that this could be an issue of paxil losing its effectiveness even more than it already had for me (and would therefore be interested to hear about ways of addressing this issue that kaiasgram alluded to, although I realize that's not the main topic here) but the timing seems awfully coincidental, especially since I am coming off a few years of managing depression/anxiety with paxil + lifestyle/diet better than I had for the two-three years previous to that when I was just using paxil and not targeting lifestyle/diet changes.
The one big difference I seem to have from micpenn is that my anxiety/depression manifests primarily as insomnia. This makes the potential overlap with cpap doubly problematic. While cpap is definitely giving me better quality sleep, to the extent that it may be aggravating anxiety/depression, it also gives me less sleep. At this point I haven't given up on it because, again, the sleep I do get is of better quality (a good night's sleep feels better and a bad night's sleep feels less bad) and I continue to hope that the anxiety/depression issues I'm seeing will subside. Plus, of course, I'm not positive that they are caused by cpap in the first place. In fact, I was hoping that cpap would alleviate my tendency toward anxiety/depression given that they sometimes correlate with OSA. No such luck, at least so far.