Reminder about corelation of OSA/CA & depression

[brain_cloud]

I believe current thinking (for what that is worth) is that the normal course of events in untreated depression is recurring episodes, and trending ever worse over time.

However, that "current thinking" is based on studies of populations of patients who had very high prevalence of undiagnosed SDB. I am skeptical as you are and think the "current thinking" is wrong.

I wouldn't call myself skeptical. There's lots that isn't known, but there is also a good deal that is pretty solid. The fact is that it is easy to produce a depressive animal in the lab (mammals anyway, don't know about amphibians). The classic way is by means of electrical shock, but it suffices to simply remove an animal from its mother or social group, or even just to raise or lower the temperature several degress outside of the animal's natural comfort zone. Any stressor will do so long as it is applied persistently. I agree with you that years of OSA is probably a common way to do the job on humans; but no doubt millions of others are produced the old-fashioned way: by years of abuse/neglect/isolation.

But my main point is just this. Once you finally stop "shocking the rat", it does not become well as a matter of course. Rather, what you most likely have on your hands at that point is a chronically unwell rat. And likewise for OSA-produced depressive "rats".

[Muse-Inc]

Joanie, great reminder re vitamin D. First thing doc said I would likely notice is a big improvement in my mood...he was right. No more endless days feeling depressed, now it's just a few hrs to a day or so and that doesn't occur very often.

[prestifare]

I believe current thinking (for what that is worth) is that the normal course of events in untreated depression is recurring episodes, and trending ever worse over time.

However, that "current thinking" is based on studies of populations of patients who had very high prevalence of undiagnosed SDB. I am skeptical as you are and think the "current thinking" is wrong.

yes and no. Years of living with lack of energy and depression can build habits of thinking that are self fulfilling after your OSA is treated.

I am getting getting therapy to deal with the last 5 years of negative thoughts which have worn a rut in my psyche. I am no longer tired in the evening but I have found it hard to break out of the routine of collapsing onto the couch and watching tv and snacking. When some suggests doing something my mind immediately nixs it because it would be too tiring despite the fact that I can easily work out for an hour after work and spend the rest of the evening sewing.

I second this. Yes, undiagnosed SDB/OSA may (or even will) cause depression, but more due to a compilation of effects than just the diagnosis itself. As Blackspinner mentions, we're creatures of habit. Years of poor sleep along with the levels of "chemical stress" caused by SDB/OSA creates patterns. We are severely short on energy. This is turn may lead to depression-related thought patterns such as inability to cope, shortcomings, self deprivation and so forth. Some studies show that over time, OSA patients "assimilate" stress as a more normal behavioral pattern due to the frequent release of stress hormones during sleep. In other words, you may feel anxious or stressed out for no apparent reason simply because your body (by way of OSA) has made a habit of it. As BlackSpinner also mentions, we also create routine habits. I would strongly suspect that most undiagnosed/untreated OSA patients share similiar experiences along the lines of having quite strict regimes for energy conservation, if you like.

Now, if you're suffering from some form of depression _and_ OSA/SDB, treating the OSA/SDB will obviously go a long way. At some point, you will sleep better, which in turn provides more energy and fewer bursts of stress hormones. Over time, established negative habits ans thought patterns may change. However, just as there is a complex set of factors that make up an OSA-related depression, I believe the process of healing one will be just as complex. Habits die hard. Depressions too. Even though CPAP therapy and the resulting increase in sleep and energy helps, I would strongly suggest some sort of therapy (primarily cognitive based) to go along with it. Years of severe sleep deprivation is a serious trauma, both mentally and biochemically.

[wearysoul]

I agree with DSM. I think depression is a natural consequence of undiagnosed/untreated OSA. Actually, I think I agree with most everything all of you said above. I also think sleep apnea is the root cause of my depression.

I’ll share one segment of my very long journey to being diagnosed with OSA earlier this year. I saw the head of the sleep clinic at UCSF in San Francisco in September 2003. (I was living in California at the time.) Although I had experienced a major bout of depression in 2000 (which I now believe was mostly due to OSA), when I went to see this sleep specialist, I didn’t believe depression was the reason for my symptoms of fatigue, body aches, insomnia, difficulty concentrating, irritability, and lack of drive. My insomnia had started me wondering if I had a sleep disorder; I was hoping I would be given a sleep study.

The doctor had other ideas. (Too bad he couldn’t have read the November 2003 article Muse-Inc referenced.)

http://www.thefreelibrary.com/Sleep+Apn ... 0109862298

He didn’t think a sleep study was warranted, and sent me away with a script for an antidepressant. I didn’t resist his diagnosis because I remembered my previous episode of depression. I proceeded to take the antidepressant and miraculously, I felt better for a few months. At first, I was angry that the doc had not given me a sleep study, but I changed my tune when I began feeling good and began to get my life back. Within five months, however, things began to fall apart. My symptoms slowly returned and I couldn’t function again. I thought the antidepressant had simply “pooped out,” as they say. My primary care physician subsequently had me try several other ADs. None of them worked. In fact, they made me feel worse. I now believe the AD stopped working because it could no longer compensate for untreated OSA.

Fast forward to late last year. I had been back in North Carolina for over a year and had been working with an excellent primary care physician and her physician’s assistant. During an office visit I was talking about my sleep problems and the PA asked if I had ever had a sleep study. I said “no,” and she said, “Well, you need a sleep study.” Imagine how I felt about all my previous high-powered doctors and their exorbitant fees when a mere physician’s assistant finally realized I needed a sleep study.

However, I didn’t rush to schedule an appointment with a sleep specialist because I still thought I had chronic fatigue syndrome (my last doctor in California had said I had CFS). Then I read somewhere that some people with upper airway resistance syndrome (UARS) are sometimes misdiagnosed with CFS; I quickly scheduled the appointment. I was diagnosed with OSA in May and here I am . . . working through all the issues around OSA therapy and recovery.

My therapy has not turned my life around. Until a couple of months ago, I resisted the idea that some of my symptoms might be symptoms of depression. I believed all of the symptoms listed above were just the result of my poor quality sleep. And I believed that optimal PAP therapy would resolve my symptoms, even if a few of them were symptoms of depression. But it wasn’t happening, and I began to rethink my belief. I asked my PCP to give me a low dose (a quarter dose) of an AD. She did, and it helped a little. I increased the dose a little, and it helped a bit more. I began to feel a little better. In a few days, I’m going to increase the dose again (the doctor has approved). I’m hoping that within a few more weeks, I’ll be feeling even better. I still have some ASV issues to resolve, but I’m now hopeful that the AD will expedite my recovery process and enable me to become functional more quickly.

So here’s my conclusion: the sleep doctor at UCSF got part of it right, but not all of it. I was depressed, but I also had undiagnosed/untreated OSA. I now believe that OSA creates the ideal environment for depression to develop. I do believe that optimal OSA therapy is the ticket to long-term recovery, but I’ve been suffering for so long that I’ve decided I can’t wait for therapy to resolve everything. I’m giving an antidepressant another try. I’ll let you know in a few more weeks how it’s going.

wearysoul

[dead tired]

I have been diagnosed with sleep apnea, and severe depression.

I've been trying to use the Resmed S8 for the past two or three years, but no matter what I normally end up removing the mask during the night as it's too uncomfortable.

I walk around in a complete daze most of the time, I don't see things improving and know I'm on a steady spiral down. Once every two or three months I get a couple of good hours of sleep with the machine.

I can't use the dental devices due to a neck injury I suffered years ago.

My point to this... I don't really know, I'm just hoping to hang on to see what happens...

dave

[dead tired]

I have been diagnosed with sleep apnea, and severe depression.

I've been trying to use the Resmed S8 for the past two or three years, but no matter what I normally end up removing the mask during the night as it's too uncomfortable.

I walk around in a complete daze most of the time, I don't see things improving and know I'm on a steady spiral down. Once every two or three months I get a couple of good hours of sleep with the machine.

I can't use the dental devices due to a neck injury I suffered years ago.

My point to this... I don't really know, I'm just hoping to hang on to see what happens...

dave

[wearysoul]

dead tired,

I noticed you just joined the forum. Welcome aboard. I'm glad you wrote. It sounds like you're suffering terribly. Maybe some of us can help you.

Have you tried any of the products to make your mask more comfortable? If not, you could try some of the Pad-a-cheek products at http://www.padacheek.com. I use the nose bridge protection, which also cushions the forehead piece on the mask. You could also try the mask/cushion liners at http://www.remzzzs.com. I use these and they have helped me control my leaks. And I think they make the mask a little more comfortable. Or maybe you need a different mask.

One more suggestion is cognitive behavioral therapy (CBT). My sleep doctor recently referred me to a psychologist for CBT. It turned out to be too expensive, so I found an online version: http://www.cbtforinsomnia.com. I haven't started the program yet, so I don't know what it's like. But you might consider it. Although you don't mention having insomnia, you may still benefit from CBT. It might help you with the issues you have with the mask.

Finally, do you have a good doctor who might help you with the depression? Have you tried an antidepresssant? I don't think antidepressants are a panacea, but if you haven't tried one, it might provide enough support to let you find a way to optimize your CPAP therapy.

wearysoul

[luv2sleep]

Glad I found this thread. I was driving to work this morning and crying. I am so tired and so tired of being tired. I have a 2 year old at home and am a single mom and it's really, really tough sometimes. I have been on CPAP for 2 weeks. I have had about 4 good days out of that. Even though my machines says my AHI levels are always less than 2, I am often times extremely tired in the mornings. Yesterday was one of those days and it was just me and my toddler at home. It was so hard. He is so little and needs so much of me and I can't give him enough when I am that exhausted. I feel so bad. Today I was feeling tired again and I am just so upset. I know that I need to exercise and lose weight but I am so tired. All that I want to do is go to bed after I put my child to bed.

[BlackSpinner]

Glad I found this thread. I was driving to work this morning and crying. I am so tired and so tired of being tired. I have a 2 year old at home and am a single mom and it's really, really tough sometimes. I have been on CPAP for 2 weeks. I have had about 4 good days out of that. Even though my machines says my AHI levels are always less than 2, I am often times extremely tired in the mornings. .

Give it time - you didn't get that way in 2 weeks. It will take your body weeks of full nights of cpap use to begin getting back its energy - then you can work out. Right now you need to give yourself time to heal. You wouldn't expect your broken leg to heal within 2 weeks in a cast so why would you expect this to heal you in 2 weeks?

[dsm]

Glad I found this thread. I was driving to work this morning and crying. I am so tired and so tired of being tired. I have a 2 year old at home and am a single mom and it's really, really tough sometimes. I have been on CPAP for 2 weeks. I have had about 4 good days out of that. Even though my machines says my AHI levels are always less than 2, I am often times extremely tired in the mornings. Yesterday was one of those days and it was just me and my toddler at home. It was so hard. He is so little and needs so much of me and I can't give him enough when I am that exhausted. I feel so bad. Today I was feeling tired again and I am just so upset. I know that I need to exercise and lose weight but I am so tired. All that I want to do is go to bed after I put my child to bed.

luv2sleep

Hang in there & do talk about it here. Be aware there will be lots of people reading this who will be thinking of you and wishing you well. The next best thing to direct prayers.

Did the good nights with the cpap help ?

Thinking of you

DSM

[SuperGeeky]

Each time I see a causation between OSA and anything else, I reverse it. I am very cynical towards Antidepressants and other medications that have effects on sleep structure and the circadian clock.

I turn a weary eye to stress, depression and medications for mental illness because they effect sleep. Sleep apnea is like a snow ball rolling down a hill. Something just needs to push the snow ball down the hill. As the snow ball gets bigger, it picks up all kinds of garbage on the way.

The new horizon for Grad Students is to examine how poor sleep architecture can open up dormant manic depressive genes, bringing on the onset of insomnia, manic depressive sleeping. And, on the insomnia side of it, worse OSA. It's an ugly dance!!

It's hard to explain... But, the overall picture on the scientific front has yet to focus, realize health sleep architecture as a common denominator of many illnesses. Likewise, many illnesses can spawn various sleep disorders.

I need to stop while I'm ahead,

Good night,

SG

[luv2sleep]

Thank you so much for your kind and helpful words! So, it will get better? Does everyone go through nights where they are still tired after using their machine all night? I use it all night, every night. I don't take it off. There are no leaks. I have a low AHI (less than 1 the last few nights). So, me being tired is just that I have to be on it a while to catch up? Ok. I can handle that and wait it out. I just was feeling like nothing is going to help.

On the 4 good days I felt much better than I have in a long time. I just wish it was every day or at least I wouldn't feel AS tired as before but just a little tired. Kwim?

Thank you again. It really helps to communicate with people who understand.

[dsm]

Thank you so much for your kind and helpful words! So, it will get better? Does everyone go through nights where they are still tired after using their machine all night? I use it all night, every night. I don't take it off. There are no leaks. I have a low AHI (less than 1 the last few nights). So, me being tired is just that I have to be on it a while to catch up? Ok. I can handle that and wait it out. I just was feeling like nothing is going to help.

On the 4 good days I felt much better than I have in a long time. I just wish it was every day or at least I wouldn't feel AS tired as before but just a little tired. Kwim?

Thank you again. It really helps to communicate with people who understand.

Luv2sleep

The stories from other members here are legion in regard to starting therapy & seeing a slow steady improvement & battling the ups & downs along the way.

The best thing you can do is what you are doing & that is to share the difficulties as you can be certain there will be many among us who know exactly where you are coming from.

It is especially touching that you have to experience this difficulty while caring for such a young child on your own plus you are obviously grappling with the extra weight issue. Believe me - many many people here know that weight guilt & challenges.

Again, know that there are people in many places thinking of you & wishing you the best.

DSM

[Muse-Inc]

Luv2sleep, you have my sympathy: single, toddler, sleep apnea -- quite a load to bear. It gets better and if you've had 4 good nights so early, keep reminding yourself of them! Took me about a month for exhaustion to turn into plain ole tired. Once I started being able to sleep well, I slept more, so go to bed early and sleep...chores can wait for the wkend, your sleep's more important and the toddler won't notice the laundry piling up . As to exercise, well, I was one of the ones with some immediate benefits and then very slow recovery; took me until 9 months to be able to do more than 3-4 mins on my exercise bike without feeling exhausted again. But then, I went from 10 mins to 40 within 10 days! I lost only 18#s the first year, then a bunch the next for a total so far of 55#s...got a lot more to go but it's slow and consistent, so I can't complain...much . Come and complain here...rants and complaints we understand!

[dsm]

Luv2sleep, you have my sympathy: single, toddler, sleep apnea -- quite a load to bear. It gets better and if you've had 4 good nights so early, keep reminding yourself of them! Took me about a month for exhaustion to turn into plain ole tired. Once I started being able to sleep well, I slept more, so go to bed early and sleep...chores can wait for the wkend, your sleep's more important and the toddler won't notice the laundry piling up . As to exercise, well, I was one of the ones with some immediate benefits and then very slow recovery; took me until 9 months to be able to do more than 3-4 mins on my exercise bike without feeling exhausted again. But then, I went from 10 mins to 40 within 10 days! I lost only 18#s the first year, then a bunch the next for a total so far of 55#s...got a lot more to go but it's slow and consistent, so I can't complain...much . Come and complain here...rants and complaints we understand!

Muse-Inc

That is a great achievement & a very encouraging story. Mine certainly isn't as tough as what you have been through but, can see where I was heading prior to going on therapy. It is fair to say I was starting to put on lots of weight, feel depressed & began worrying about keeping alert at work. That fear may have been my greatest motivator to do 'whatever' it took to get on top of the problem.

Am in no doubt that stories like yours can do most turn Luv2sleeps's life around by providing proof of hope rather than a dream or a promise of it.

A terrific contribution.

DSM