Medication affecting AHI?

[Outlier]

I have been going through major life changes, experiencing debilitating depression and anxiety, included anxiety attacks. I am currently on Citalopram 30 mg a day and Xanax 1 mg 3x a day. My AHI has shot up from an average of 2-3 before the medication to about 7, and has been as high as 12. I asked my doctor if these meds affect apnea, and he didn't seem to think so, other than the Xamax slowing my breathing.

The problem here is that there are two variables at play - it could be one medication or the other. Or maybe more than two variables, such as the stress, anxiety and depression. This makes it hard to narrow down what exactly is going on without eliminating all variables but one, seeing how I respond, then eliminating that variable, etc. This is just not possible right now because I need these meds to cope, even though I'm having therapy sessions every two weeks.

Any ideas?

[old dude]

Unless one of these two meds potentiates the other, I wouldn't think the Xanax would be at fault here. It actually should make your AHI better, given that it will keep you from sleeping as deeply where events are more likely to occur. I've taken it for a long time, and I will say that 3 mg/day is a pretty substantial dose. At my worst I took 4 mg/day, but those were some awfully tough times...

[Julie]

http://www.drugs.com/sfx/citalopram-side-effects.html

[ems]

I have been going through major life changes, experiencing debilitating depression and anxiety, included anxiety attacks. I am currently on Citalopram 30 mg a day and Xanax 1 mg 3x a day. My AHI has shot up from an average of 2-3 before the medication to about 7, and has been as high as 12. I asked my doctor if these meds affect apnea, and he didn't seem to think so, other than the Xamax slowing my breathing.

The problem here is that there are two variables at play - it could be one medication or the other. Or maybe more than two variables, such as the stress, anxiety and depression. This makes it hard to narrow down what exactly is going on without eliminating all variables but one, seeing how I respond, then eliminating that variable, etc. This is just not possible right now because I need these meds to cope, even though I'm having therapy sessions every two weeks.

Any ideas?

I wish I knew what to tell you, but I really don't. I do think that the depression/anxiety along with the meds you are taking are all playing a role here. I don't agree with your doctor... the meds you are currently taking can and probably are messing with sleep architecture. Do you see a sleep specialist? It would be a good idea to run this by him/her. Maybe your pressure can be adjusted to accommodate your med situation.

It's good you are seeing a therapist. Be careful with the xanax. I'm sure you already know that it's highly addictive.

I hope things start to settle down for you! Life changes aren't easy... I know because I'm dealing with them myself.

[Jay Aitchsee]

Outlier, a quick Google search will turn up quite a few references such as this one, https://www.healthtap.com/user_question ... leep-apnea , which warn of the possible negative impact of benzodiazepines, including Xanax, on respiratory function.

[Outlier]

Thanks everyone for your input. I've only been taking these medications about 2 months, and it's been a constant process of adjusting dosages to control my symptoms, so I'm hoping that I'm just adjusting to the increased dosage and my AHI will eventually go back to where it should be.

[Guest]

I occasionally take a relatively tiny dose of Xanax - 0.25 mg once or twice daily, and so far, each time my AHI was much lower on it.
Jim

[zoocrewphoto]

What are you pressure settings? Have you looked at your data to see the breakdown of your events? How to deal with the increased ahi will depend on what type of events you are having.

Are you are topping out at your max pressure? If you are, and the events are not centrals, then you may need to increase your maximum.

My own settings are 11-17. I spent most of my night in the 11-13 range, with a couple spikes to 15 or so, and some nights, some very short spikes up to 16.9. One thing that is nice is that I have to take a muscle relaxer, I don't have to worry about it making my apnea events worse. The machine is already set to a range that can handle the effects of the medication. So, instead of more events, I have more and/or longer increases in pressure. And I don't have to do anything. The machine takes care of it.

If you can extend your range to handle the situation successfully, then you won't have to worry about the medication having an effect on your sleep apnea.

[Outlier]

My pressure is set at 10-15, and last night I averaged 14.8 with an AHI of 6.6. I'm considering upping the pressure, but I want to give the meds a couple of weeks to adjust to see if it lowers on its own. Like I said, before the meds I was averaging and AHI of 2-3, and it wasn't unusual to be under an AHI of 1.

[avi123]

Outlier, see here where to go for medical care

[robysue]

Outlier,

I'm going to assume that at present you have good reason to believe there are some real potential benefits of the Citalopram and Xanax as far as treating the depression and anxiety are concerned. In other words, I'm going to assume that at least for now you want to give those drugs a real chance to help with the conditions they've been prescribed for.

And so the question becomes: What to do to minimize their possible affect on your OSA, particularly since you write:

My pressure is set at 10-15, and last night I averaged 14.8 with an AHI of 6.6. I'm considering upping the pressure, but I want to give the meds a couple of weeks to adjust to see if it lowers on its own. Like I said, before the meds I was averaging and AHI of 2-3, and it wasn't unusual to be under an AHI of 1.

You might want to look carefully at some of your daily data.

Was there a sudden increase in AHI just after you started taking the Citalopram and Xanax? Or has there been a gradual rise in the AHI over time and then a jump with the start of the medicine? Is it possible that the AHI started to increase before you started the medication? In other words, as the anxiety and depression grew, how did the untreated anxiety and untreated depression affect your sleep in general and your AHI in particular?

And what's the mix of events that causes the AHI = 6.6? Is it mostly OAs and Hs? Or is it mostly CAs? Or are OAs, CAs, and Hs all about equal? Or does it vary significantly from day-to-day?

Because several things could be going on here---you noted yourself that there are at least two variables in the mix, and probably more.

If there was a sharp sudden rise in the AHI that began right after you started taking the Citalopram and Xanax, then one or both may indeed be doing something that aggravates the apnea. But are the events OAs and Hs? (The medicine is allowing the throat to relax more?) Or are a lot of the new events CAs (The medicine may be affecting the urge to breathe more than it affects the muscle tone of the airway?)

If most of the new events are OAs and you're regularly topping out at your max pressure, bumping the max pressure up by 1cm might help quite a bit. But if most of the new events are CAs, bumping the pressure up a bit probably won't do much good.

[Outlier]

I will review the data when I get a chance later and get back to you, Robysue. And yes, these medications are of tremendous benefit at this time. I have to function at work, live my life, etc., and without them right now I don't think I would be doing any of these things. My meds are carefully coordinated between my PCP and my psychologist, and I view them only as temporary aids. But the AHI did spike immediately after beginning these medications.

[robysue]

I will review the data when I get a chance later and get back to you, Robysue. And yes, these medications are of tremendous benefit at this time. I have to function at work, live my life, etc., and without them right now I don't think I would be doing any of these things. My meds are carefully coordinated between my PCP and my psychologist, and I view them only as temporary aids. But the AHI did spike immediately after beginning these medications.

If you have a sleep doc as well as the PCP, you might want to bring him into the loop as far as what's happening.

[zoocrewphoto]

You might try raising your minimum to 11 or 12. It may be taking too long to get to you needed pressure which allows some events to get through. If it isn't topping out much, I would leave the maximum the same for now.