CPAP, Depression and SNRI’s

[GHM]

Hello. This is my first question and I hope the only one I have

I’ve been using a cpap for a month now for OSA treatment. I have yet to see much benefit but the more I read on here the more it seems to possibly be due to medications I take. I am starting to feel like I’m stuck in some sort of circular problem. I went for a sleep study for the classic “wife elbows me when I stop breathing” issues and really didn’t know about the other benefits. See I take Fetzima for depression/anxiety which I have always thought was just my messed up head but as I read how much apnea can impact these conditions I am curious if this is a big part of my problem.

But, I’ve also read here that SNRI drugs like Fetzima interfere with sleep. I seem to go to sleep easily enough but wake up about 2 am every night and lay awake for hours trying to get back to sleep or I wake up multiple times. I occasionally take a sleeping pill when I have to get some sleep but otherwise I never go to sleep and stay asleep through the night.

So I feel like I’m caught in this catch 22 situation. I may be depressed because I don’t sleep, but the pills I take to manage the depression keep me from sleeping. I won’t make med changes without the support of my doctor but I feel like I need to stop the meds to see if I sleep better to maybe relieve the depression etc. I’m sure I’m not the first to have to deal with this. Has anyone else had any experience with this sort of issue? I’m also afraid to go off the meds, and so is my wife, because the last time I was off it was no pleasant. I am very quick to anger when I’m off the meds. Almost led to a divorce last time.

I just feel trapped and unsure how to proceed. Any thoughts would be appreciated.

[Pugsy]

Welcome to the forum.

Have a heart to heart discussion with your doctor about your concerns and options for either changing meds, dosage, time of dose or even going off the meds while under strict doctor's supervision (most likely slow tapering down on the dose).

Do NOT attempt cold turkey quitting on your own.

[greatunclebill]

i was on ssri zoloft 150 and the doc changed me to snri cymbalta 90 because it also acts as a pain reliever. i weaned off of zoloft while taking cymbalta simultaneously which took about 3 months. when i was fully on cymbalta i started having sleep problems like moving limbs in my sleep, falling out of bed, acting out dreams to a degree and waking up. when he weaned me back down to 30, all was and still is good. your dosage may be wrong. talk to the doctor in the morning.

[Nick Danger]

I agree with Pugsy's comments. Talk to your doctor. Is the doctor who prescribed the SNRI a psychiatrist? If not, consider talking to a psychiatrist about your situation - they will be more knowledgeable about the various antidepressants and both their therapeutic effects and side-effects.

To emphasize Pugsy's recommendation - do not quit the SNRI cold turkey without consulting with your doctor.

[jnk...]

You AREN'T stuck. Many meds affect sleep, but getting PAP set up just right can help things improve over time. Optimized PAP therapy can affect dosage of many medications. So priority number one is to get your PAP therapy optimized, since doing that can make most everything in life better.

[GHM]

Any advice on optimizing pap therapy or to be honest what that even means? I am still struggling to find a mask I can stand so I know that’s part of it but beyond that I don’t know what else I could do. My machine seems to be set at a constant 10 cm H2O based on the sleep labs review of my tests.
I have had 2 in lab tests and for the first month I used a loaner machine that reported results via cell back to the provider.
I know I need to download sleepyhead but don’t have a computer to put it on (just iPads and a work computer I can’t load software on).

I am using a nasal pillow mask and I don’t know that I like it. I also tried a nasal mask and thought this would be a better seal with facial hair but it actually hurts after a few hrs. But maybe it’s just a getting used to it period.

Thanks again all and I definitely won’t be going off the meds without doctor support.

[Pugsy]

We really can't offer much beyond the very most basic of advice when we have no data to base any suggestions on....and that means the software reports which you can't get until you can get hold of a computer where you could load up SleepyHead.
There is very limited data available on the machine's LCD screen...pretty much generic AHI and leak data.
Your machine..the DreamStation Pro model is a fixed pressure machine...that's all it can do unless you played with the limited apap trial mode but without software to guide you there it's kind of a waste of time.

Can you see what limited data is available from your machine?
If not...just a matter of turning on a little setting in the clinical menu.
Request the manual and it will explain how to turn the "show AHI" setting on so you can view the data that the machine does offer.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

Check to see what your AHI is and how the leak management is going.
Take a hard look at how many hours of real sleep you are getting and how many wake ups you might be having.

SSRIs and SNRIs....known culprits for messing with sleep architecture...causing insomnia and extreme fatigue during the day.
You already know that.

Do you have any way to upload a zipped/compressed copy of your SD card so you could send that zipped file as an attachment?
If you can and you wish to send it to me...I can run it through my SleepyHead and get you some reports for a starting point.
It has to be a mirror copy of your SD card though and not bits and pieces of files because I can't rebuild it.
If you want to do that...send me a private message and I will give you my private email address to send the attachment to.

[Cpapian]

Hello. This is my first question and I hope the only one I have

I’ve been using a cpap for a month now for OSA treatment. I have yet to see much benefit but the more I read on here the more it seems to possibly be due to medications I take. I am starting to feel like I’m stuck in some sort of circular problem. I went for a sleep study for the classic “wife elbows me when I stop breathing” issues and really didn’t know about the other benefits. See I take Fetzima for depression/anxiety which I have always thought was just my messed up head but as I read how much apnea can impact these conditions I am curious if this is a big part of my problem.

But, I’ve also read here that SNRI drugs like Fetzima interfere with sleep. I seem to go to sleep easily enough but wake up about 2 am every night and lay awake for hours trying to get back to sleep or I wake up multiple times. I occasionally take a sleeping pill when I have to get some sleep but otherwise I never go to sleep and stay asleep through the night.

So I feel like I’m caught in this catch 22 situation. I may be depressed because I don’t sleep, but the pills I take to manage the depression keep me from sleeping. I won’t make med changes without the support of my doctor but I feel like I need to stop the meds to see if I sleep better to maybe relieve the depression etc. I’m sure I’m not the first to have to deal with this. Has anyone else had any experience with this sort of issue? I’m also afraid to go off the meds, and so is my wife, because the last time I was off it was no pleasant. I am very quick to anger when I’m off the meds. Almost led to a divorce last time.

I just feel trapped and unsure how to proceed. Any thoughts would be appreciated.

Sometimes, when one can't sleep, it's easy to play the blame game. Blaming the drugs is easy. Maybe it is right or maybe it is wrong. If one has a natural tendancy to insomnia, drug, in their infinite good nature generally heighten it.

What do you know about sleep hygiene? Google the term and learn about it. Try putting the recommendations into effect. People write books about it, so it's unnecessary for me to go into detail when I know virtually nothing about your personal situation. Then in terms of insomnia, there are a number of different types. So you pretty much need to know your type of insomnia to work on your best solution. Unfortunately, there's no magic pill for this. Your work and efforts are the only thing that counts.

Alternatively or in conjunction with the above, you could check with your doctor about trying a different medication. Another medication might work better for you.