your experience with medication and sleep apnea

Hi all,

I have OCD/depression/anxiety. My psychiatrist increased my lexapro from 10mg to 20mg every morning, and prescribed taking 0.25-0.5 mg of ativan at night to help with anxiety when I first wake up. So now I'm taking:
morning: 20 mg lexapro, 1 mg ativan
night: 0.25-0.5 mg ativan

I've noticed that my sleep has gotten worse since around the same time as the increase in meds, and it's a struggle getting out of bed before 10am. Luckily I have a job that's flexible, but I don't like having the worsened sleep and getting out of bed that late. I left a voicemail for my psychiatrist telling him that worse sleep/waking up late is adding more anxiety anyway and that I would like to stop taking the ativan at night.

I'm wondering what your experience with lexapro/ativan and sleep apnea has been like? And are there any medications that were better in regard to sleep apnea? (I know it differs from person to person).

Thanks!

I have similar issues as you. Except for that I do not have OCD. My depression and anxiety can be crippling at times. I am prescribed 0.5mg clonazepam twice daily, methotrimeprazine 50mg twice daily, and mirtazepine 45mg at night. The methotrimeprazine is a sedative that I use as a sleep aid as well as an anti anxiety medication, and the mirtazapine (remeron) is an anti-depressant that acts as a sleep aid as well. In spite of those meds, my AHI is below 5 all of the time. What I do know is that sedatives of any kind can supress the respiratory system, worsening OSA and CSA. My doses are small enough so that they do not aggravate my sleep apnea too much. I would assume the same thing for you, since you do not have particularly high doses. On the other hand, everybody reacts differently to medication, so maybe your are more sensitive to them than I am, which results in a worsening of your sleep apnea symptoms. A higher pressure may help you out. But in your case, you should definitely consult your doctor about your situation, he/she will be able to help you more than anybody on this board will be able to.

Have you looked at the side effects for these two meds?
Somnolence
Insomnia
Sedation
and others
http://en.wikipedia.org/wiki/Escitalopram
http://en.wikipedia.org/wiki/Lorazepam
please note this special notation for Ativan...
Sleep apnea – Sleep apnea may be worsened by lorazepam's central nervous system depressant effects. It may further reduce the patient's ability to protect his or her airway during sleep.

Dosage was doubled...doesn't surprise me one bit that you can't wake up in the AM. I would be a walking zombie....if I could walk.

I do know about the sleep-related side effects, but I'm kind of in a bind: if I don't take the meds, my OCD/anxiety are worse, but with this increase, my sleep is getting worse (it wasn't that great even on CPAP, but at least I could get out of bed before 8:30 am)

I need to find a middle ground between treating my OCD/depression/anxiety and getting good sleep.

I understand being caught between a rock and a hard place in your situation. It's always possible that with time your body will adjust to the increased dosage and the negative side effects will diminish.

Perhaps discuss the situation with your doctor...maybe compromise a bit and increase the dosage gradually.
If the prior dosage side effects were more manageable maybe going up in dose slowly instead of a straight up doubling would be less of a problem.
Or just give it time to see if your body can get to the point that it doesn't knock you on your butt as it gets used to the additional drugs.

also...what do you mean by "sleep is getting worse"...is it just the fact that you are having difficulty waking up in the AM or has the sleep during the night changed and if so, how?
Like are you waking more often during the night? Sleep apnea worse?

Jak3099 wrote:I do know about the sleep-related side effects, but I'm kind of in a bind: if I don't take the meds, my OCD/anxiety are worse, but with this increase, my sleep is getting worse (it wasn't that great even on CPAP, but at least I could get out of bed before 8:30 am)

I need to find a middle ground between treating my OCD/depression/anxiety and getting good sleep.

Perhaps it's time to try a different OCD/anxiety medication altogether? There has to be something else that could be prescribed for the OCD/anxiety issues other than simply doubling your doses of lexapro and ativan.

What to try may depend on whether the OCD or the anxiety is the larger issue. There are other medications that can be prescribed for the anxiety issues.

Pugsy wrote:also...what do you mean by "sleep is getting worse"...is it just the fact that you are having difficulty waking up in the AM or has the sleep during the night changed and if so, how?
Like are you waking more often during the night? Sleep apnea worse?

Besides having trouble waking up in the AM, I noticed my average AHI increased from ~0.2 - 0.7 (I know they are still good numbers), and most of the events are obstructive, the same time as the increase in meds at the end of June. (15 mg for 1 week, then moved on to 20 mg)

I just heard back from the psychiatrist, and he said it should be fine to omit the nighttime ativan and see how things go. I'm also going to make more routine use of my neti pot to help with my congestion

You posted: "I need to find a middle ground between treating my OCD/depression/anxiety and getting good sleep." I would look toward Alprazolam (generic Xanax) and take it once a day on the P.M. Ask your shrink about it.

avi123 wrote:You posted: "I need to find a middle ground between treating my OCD/depression/anxiety and getting good sleep." I would look toward Alprazolam (generic Xanax) and take it once a day on the P.M. Ask your shrink about it.

Thanks! I'll ask about it

Ativan and Xanax have pretty much the same effects and side-effects. For most people the half life of Xanax is a bit shorter than Ativan. If the purpose is to mitigate morning anxiety, then you would want the medication with the longer half life. This decision is best left to Jak and his psychiatrist.