Untreated sleep apnea and antidepressants

[blowfish]

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[lovey]

It was interesting that when I was diagnosed with sleep apnea two years ago, it was the psychiatrist who thought I had sleep apnea and made the referral for a sleep study. Not my primary care doctor, not my cardiologist, not my neurologist. The psychiatrist thought that maybe my strange nighttime behavior, i.e. headbanging, sleepwalking, etc. could be that I was in an altered state because of a low oxygen level. I ended up being diagnosed with severe sleep apnea, and since I have been treated, I no longer have the strange behaviors. I definitely believe that there is a direct relationship between sleep apnea and mental health!!

[oxygenium65]

I took a phone call to sleep nurse today ( there's no sleep doctors you can get touch with phone), she told me to wait my appointment and cpap treatment... "cpap maybe helps with your depression too". She didn't comment about my antidepressants recipe/treatment. Of course... because she's not the doctor who wrote me the order/recipe...
Most of people i had talked about this, including all my closest family, are thinking i'm stupid if i start to take those antidepressants before cpap.
I know it sounds paradoxal, but i think... "Whatever..so what.. maybe i take a pill.. it's doctors order.. but he didn't know a shit about sleep apnea!"

[DreamDiver]

...I know it sounds paradoxal, but i think... "Whatever..so what.. maybe i take a pill.. it's doctors order.. but he didn't know a shit about sleep apnea!"

I get the impression that in Finland, there are month-long queues of people waiting to get cpap machines. If that's true, ouch. While there really isn't any such thing as 'normal', I don't see that unconscious activity such as 'purposefully banging your head against a wall' is something that would necessarily lead to the conclusion that CPAP therapy alone would be the answer. Without really knowing more about you or the doctor, I have to agree with the doctor that antidepressants are a good first step to help out until you can actually get into cpap therapy. Once you're in a stable sleep situaton, the antidepressants could probably reduced or stopped - again at the suggestion of the doctor.

If the problem is that the doctor just wants you to start antidepressants before cpap therapy - not that there are queues waiting to actually get titrated - then I agree with your family and friends. Find another doctor and get a second opinion. To me, it always seems better to start with non-pharmaceutical methods if that is all it takes. The only time I'd say otherwise is if you're physically damaging yourself. I hope you're not.

The important thing is to talk charge of your health, and if you can't, have someone in your family act as patient advocate to better explain your position to the doctors and nurses.

[roster]

......I'm not "fully functional" and i am "missing work" i definitely NOT having "suicidal thoughts".
Topmost feeling and emotion is exhaustion, dead tired and maybe some anger because i haven't energy enough for my kids and wife.
......

These are typical symptoms of untreated sleep apnea. There is no antidepressant drug that will appropriately address this problem. Worse yet, every antidepressant drug brings undesirable side effects.

DD, I am totally in disagreement with you on this one.

[DreamDiver]

DD, I am totally in disagreement with you on this one.

Sorry rooster - it's the part about the repeated head bumping that concerns me.

I think we both agree that the ideal situation would be for oxygenium65 to get titration tonight and get a machine tomorrow. That would be the best answer. No drugs. We're in agreement there.

But he has to wait a month, probably because the line to get titrated is a month long. If he's bumping his head just because it's dark and it's accidental, okay. You're right. No antidepressants are indicated. However, if it's intentional, where he is actively seeking walls to bump into while asleep - that's a depression thing. I can only gather the doc may think the head bumping is intentional and so wants to insure that oxy doesn't hurt himself because of depression before he can actually get titrated. The doc could be doing a CYA - which would be bad. I agree with you on that premise too. I also agree that antidepressants won't fix any of the other symptoms at all.

However - not knowing either the doctor or the patient in person, I'm inclined to recognize that we as 'walking dead' stage apneacs may not be ready to make the best assessments. The doctor presumably is. If the doc sees multiple lacerations and bruises, but can't get him titrated sooner than a month, and he's ready to hurt himself intentionally if only unconsciously, would those be grounds for using antidepressants until time of titration?

[roster]

......If the doc sees multiple lacerations and bruises, but can't get him titrated sooner than a month, and he's ready to hurt himself intentionally if only unconsciously, would those be grounds for using antidepressants until time of titration?

DD,

Isn't that embellishing the condition in which Oxy describes himself?

I may be making some overly optimistic assumptions about his condition based on his statement that he is not suicidal.

But in any case, are there any antidepressants known to prevent headbanging and sleepwalking? Maybe I am restating myself, but if you are known to be an untreated apneic, I would be more concerned that the side effects of antidepressants would make the problem worse.

.........
My doctor says that C-pap don't help much for depression.
.......

I categorically would not trust any prescription from a doctor holding this view!

BTW, Oxy, did we suggest sleeping on your side until you can get a cpap (and maybe thereafter)? My SWAG is that about 40% of OSA cases are positional and are less severe while sidesleeping as compared to backsleeping.

[blowfish]

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[smurf]

Still being a newbie here, I am concerned about some of the advice given here at the forum. Some people that are very veteran here have very stong opinions about what they know. I also believe that in most cases some of the veterans know more than a lot of the health professionals in sleep apnea issues. However.....I do not believe that anyone on this panel can be absolutley sure about banging of heads on walls when possibly associated with sleep apnea or depression. I feel we can offer our opinions and offer our best advice, but we need to be careful about trying to override a Doctor of Medicine when they know more about the other health issues (depression) than most of us sleep apnea experts. I would also quanify by saying that the banging of heads on walls is beyond normal for sleep apnea symptoms and for depression symptoms.
If you absolutley sure that you are 100% positive that someone must go against a Doctors advice on a head banging case because you are an expert in the field then have at it...
If on the other hand you are against the diagonoses of depression because it is one of the most common mistakes made with sleep apnea patients, don't advise out right that the doctor be ignored. In the end, depression may be a proper diagnoses. You may be wrong. You don't know, I don't know, apparently the Doctor may not know, but bottom line is........Taking such hard stance is careless.
I understand a lot of us are weary of a Doctor's advise (we should be!!!!), so we must encourage learning by listening to others on this forum, doing ones own research, and getting a second opinion.
I salute DreamDivers ability to educate as best as possible, and not telling someone to go against Doctor's advice, because DreamDiver acknowledges this is beyond what we are here for......
Rooster, you are probably right, but are you willing to take responsibility for it if you are wrong? I agree with virtually everything you said other than your implied insistance that you are right. You are probably right, but could be wrong and the advise given should reflect that. Dreamdiver's advise reflects that.
I feel that medical conditions are like the masks that we all try to wear. We all have different shapes, sizes, sleep in different positions, and react to masks in all different ways. I think the same applies to medical conditions. We all must find out where we are individually with conditions. What causes my depression and how I react is different than a lot of people, but I am sure the same as some one else.
Please keep offering advise and opinions in this great forum. I have learned a lot!!!!

[blowfish]

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[oxygenium65]

I think we all are sharing only opinions, not diagnosies. That's why we are posting here. Responsibility for actual actions are 110% mine.
It's very encouraging to find different perspectives from comparable group. I'm not trying to override a Doctor, but there are different types of
good Doctors: Experts .. and not so experts
Like i wrote: "Whatever..so what.. maybe i take a pill.. it's doctors order.. but he didn't know a shit about sleep apnea!". I respect that Doc, even if
i completely disagree. I understand there's of course possibility that i can't see the whole picture myself. I wouldn't bet on that

My worst "headbanging" at the moment is that i'm only lie on a sofa, my right hand on laptops trackpad (it's on a side-table),
and maybe sometimes "headbanging" in rhythm with some great music
I don't think this is too dangerous behavior... I have still a number of interesting things in my "to do list", i just don't have energy.

I do have depression symptoms, but i repeat - never suicidal feelings.. Reverse... i want my life back!

BTW. I practise sidesleeping, big meaning in my OSA (sleep study - 41,7% backsleeping) ... it's not easy.

[roster]

........ ......
BTW. I practise sidesleeping, big meaning in my OSA (sleep study - 41,7% backsleeping) ... it's not easy.

I was primarily a backsleeper and converting to sidesleeping exclusively is very difficult for me. My titrated pressure is 19 cm on my back and 8.5 cm on my side. 19 cm is extremely difficult for me, so I am forcing backsleeping. This is certainly difficult for me.

On the main point, doctors missed my OSA diagnosis and had me try three different SSRIs. I only tried each for a few days. They made the OSA worse and made my entire digestive system very ill. The third SSRI caused those electrical shocks when I discontinued it even though the dosage was the smallest available and I took it for only about a week. Those were horrible times for me. I am happy to say I am drug free today.

BTW, what music do you enjoy?

Regards,

[roster]

.....Rooster, you are probably right, but are you willing to take responsibility for it if you are wrong? .....

Is the doctor willing to take responsibility because he is wrong? Of course not, that is why they have large liability insurance policies. As it is said, doctors just "practice" medicine.

[roster]

.......I do notice on the nights it (cpap) works I am better ready to face the day and nothing can make me feel depressed. But when I wasn't on the Cpap at all every day was a challenge just to get out of bed.

Excellent argument against allowing a doctor to experiment on you with drugs.

And it is experimenting. It has been about 15 years since I read the book Listening to Prozac which is the landmark book promoting SSRIs. The author describes in the book how a doctor should prescribe an SSRI to a patient and then wait to see if the patient's condition improves. The author claims if the patient improves then he must have been depressed and should continue on the SSRI. Doctors practice.

[mindy]

It has been about 15 years since I read the book Listening to Prozac which is the landmark book promoting SSRIs. The author describes in the book how a doctor should prescribe an SSRI to a patient and then wait to see if the patient's condition improves. The author claims if the patient improves then he must have been depressed and should continue on the SSRI. Doctors practice.

As you noted, Rooster, it has been at least 15 years since that book came out. There's much more information on neurotransmitters today. Although there are not yet (as far as I know) tests sophisticated enough to determine which antidepressant will work for whom, the "practicing" has, imho, become more informed, though certainly not perfect!

Mindy