Depression or sleep deprivation???

[snoozeandlose]

Hi
I have been using a cpap for about three years with mixed results. I am 55 and have recently lost 30 pounds. I am a mouth breather and use tape to keep my mouth shut since a full face mask didn't work for me. About a year ago the day time sleepiness got much worse. I had a new sleep study that was lousy, but did increase the pressure from 10 to 12. I didn't notice much difference.

I am and have been on antidepressants, but they never seemed to cause daytime sleepiness. I have also been on ADD meds which may be contributing to the feelings of sleep deprivation. I stopped that med for awhile and didn't notice any difference in the sleepiness and fatigue. However I think it may be keeping me awake at night now. I have never had trouble falling asleep until I recently began taking adderal xr. A few weeks later my psychiatrist started me on Ambien which after reading other posts on this site may be another reason I am so tired during the day. Anyway ,now the Ambien is not helping me fall asleep and I only sleep for six hours. And I am still feeling exhausted and have foggy thinking. Any advice?

[bank4cat]

Hello i am on 40mg prozac and 60mg of adderal and 10 is my pressure setting . I have been on the adderall for about as long as i have been on cpap around 3yrs. I have been more alert during day and had no problems sleeping now that i added prozac i feel sleepy during day, unless i need a pressure change. I know if u start out on a low dose of adderall it can cause a sleepyness during the day.

[LemonZest]

My psychiatrist currently has me on 60 mg Cymbalta, 30 mg Adderall XR and 10 mg of Ambien as needed. I wasn't diagnosed with sleep apnea until recently, so I'm not sure how that fits into my condition yet, but I'm constantly exhausted during the day. I've found that Adderall XR is pretty much the only thing keeping me awake at work, but its effectiveness has decreased over time. When I first started it I was so hyper, but I could feel an underlying weariness that never quite went away and eventually got stronger than the hyperness.

As for Ambien, in my experience it causes more problems than it fixes. Although drugs affect people in different ways, I wouldn't recommend Ambien to anyone because it leaves me feeling drugged the next day. It knocks me out, but it doesn't keep me asleep. I tend to wake up a few hours after taking it.

That's my personal experience with Ambien and Adderall XR. I know that Ambien is meant to be a short term sleeping aid (7 - 10 days), so resistance can happen quickly. You mention that your sleep study was "lousy" so I wonder if your pressure settings aren't tweaked just right yet... Also perhaps your doctor could get you a different prescription sleep aid. Just because Ambien is widely prescribed doesn't mean it's the best for you.


There's so many factors that could cause your sleepiness that it's hard to pinpoint one thing for sure. You mention that you recently lost weight, but is it due to exercising or a diet adjustment? I've found that exercise helps me sleep better at night (when I actually make myself do it), and I know other people who say the same. What I've learned from my experience is to not assume the depression is causing the sleeplessness; it could even be the other way around! It's easier to try to fix other things before you can fix the depression, so I'd start from that end.

My constant fatigue has been plaguing me for years, and all my previous psychiatrists just attributed it to the depression, but I'm so glad that my recent one referred me to a sleep clinic. I hope that CPAP can help me feel more rested once I get used to it!

[kteague]

Hi. First off, congratulations on the weight loss. Sorry your sleep study a year ago was "lousy" - I'm only guessing that was because you didn't sleep enough to get solid results. You've tried ruling out different causes. It's so hard to interpret results when you don't have a baseline from which to gauge any changes. For instance, I have multiple sleep disorders (to include OSA, RLS & PLMD) and in trying to determine if I have Narcolepsy, the docs at Cleveland Clinic said that before anything else they wanted to establish that my I was consistently getting a minimum of 6 hours of quality sleep before evaluating any residual daytime sleepiness. I think the same general principle applys for most who still have daytime sleepiness - you've gotta KNOW if your cpap therapy is working first. Unless that is confirmed, everything else is a guessing game. How you can make that happen will depend on your personal circumstances with your doc, insurance, finances, etc. Because it answered my questions, I advocate getting an autopap as a loaner for at least 2 weeks to see if your titrated pressure of 12 is working for you. Where to go from there will be clearer - masks, meds, etc. Best wishes.
Kathy

[Snoredog]

I don't want to sound like that idiot Tom Cruise here, but I would try and wean myself off the shoebox full of drugs, none of that stuff is really good for long term use. Ambien is known to leave you feeling groggy the next day and in the "fog".

I would think that if you lost 30lbs. that your pressure requirement should have dropped instead of increasing?

Could it also be your machine is not working for you? Have you checked the actual delivery pressure on your machine?

What it says on the LCD and what an external manometer says it is actually delivering may be two different things. Then your particular breathing pattern may one where your current machine may not be responding correctly.

If your current machine checks okay pressure wise, I would still try a different autopap, I suggest a new M series Remstar Auto w/cflex so you can get some data results from the LCD.

Do you have Silverlining software for your 420?

If so, what are the reports saying? What did your last sleep study show? Do you have those results?

[jskinner]

I am and have been on antidepressants, but they never seemed to cause daytime sleepiness. I have also been on ADD meds which may be contributing to the feelings of sleep deprivation. I stopped that med for awhile and didn't notice any difference in the sleepiness and fatigue. However I think it may be keeping me awake at night now. I have never had trouble falling asleep until I recently began taking adderal xr. A few weeks later my psychiatrist started me on Ambien

Adderal is a simulate so its not suprising that its affecting your sleep. If your still tried you probably need to work on tweaking your OSA treatment rather than taking a stimulate. What antidepressant are you on? Most AD affect your sleep in one way or another (either giving you insomia or making you sleepy or fatiqued).

I spent many years being put on psychiatric drugs for my tiredness when the root cause appears to have been the OSA. Once on these drugs its often very hard to get off. I was put on many sedating drugs to try and make my sleep better and was told it was impossible that my sleep was getting worse. Turns out many sedating drugs make apnea worse... Many doctors don't know much about OSA, be careful...

[birdshell]

I don't want to sound like that idiot Tom Cruise here, but I would try and wean myself off the shoebox full of drugs, none of that stuff is really good for long term use. Ambien is known to leave you feeling groggy the next day and in the "fog".
(snip)

RE: The red text (I colored it to highlight it)

I am not a medical professional, so the following is my humble opinion:

Snoredog,

I am sure that you had only the best intentions in your posting.

Even if you do not wish to sound like Tom Cruise, your comment is a bit shortsighted. While everyone should take the minimal amount of medication that has the optimal effect, some cannot wean off them. There are those who have a CHEMICAL imbalance in the brain for some reason, and therefore are unable to function as so-called "normal" folks.

If some, such as paranoid schizophrenics, do not take their medication we may all suffer from their actions. Several schizophrenics have become murderers. On a lesser level, they can cause problems for themselves and others with some extremely dramatic behavior problems.

In addition, we must (or the healthcare workers we trust to do so) must always weigh the risks vs. the benefits of ANY treatment. Treatments are not just chemically based; some, such as ECT, are very effective and yet have side effects. Surgery for serious epileptics may work a seeming miracle, but not without some problems shifting bodily operations to other brain centers.

Even if they appear to be "normal" we do not know what they have to do to recover from that dinner or social party. Someday maybe the true causes will be known, but is it better to be a wildly fluctuating bipolar human being, or to take a few pills per day? Even if the pills do cause some damage physically, what about the quality of life without them? Would the resulting social and emotional toll REALLY be worth the extremes of the peaks a and valleys ?

How different is this from taking medications for actual physical diseases or anomalies? Insulin for diabetics may be not so good for long-term use. Anti-convulsants for epileptics may not either, but rather than seizing and sleeping as much as many times a day, they might actually be able to function as contributing and accepting members of society. ADHD medications may have side effects, but what about the side effects of being unable to learn well without them? Will those people be functioning adults?

It is a good thing that we live in a time when the truly bipolar (and otherwise mentally ill folks) are not simply locked away. And we have not considered the vast variety of the mental illness spectrum; there are so many! It is my belief that someday in the not-too-distant future that our methods of treating brain chemical imbalances (such as mental illnesses) will be considered just as shockingly cruel as that of the insane asylums in our not-so-distant past.

[Jere]

I don't want to sound like that idiot Tom Cruise here, but I would try and wean myself off the shoebox full of drugs, none of that stuff is really good for long term use.

My thought here, is please don't say things like this until you have walked a mile in my shoes.

Boy, would I love to just dump all of the meds and just be normal - wouldn't that just be great. Unfortunately, heredity had other things in mind for me. Due to a long (and hidden) history of mental illness on my mother's side, I have struggled with anxiety and depression my whole life. By the way, depression and anxiety really screw up sleep. It took years - no, decades - for me to find doctors that would even take me seriously (they all thought I was just looking for scripts). A good psychiatrist (who realized that the antidepressant route really was not working) sent me to a pharma-psychiatrist who finally put me on the right meds (NOT anti-depressants). Is my struggle over - no - but it is better. But that 'shoe box' of meds ain't going anywhere and that is something I have learned to accept.

And the funny thing is that by looking at me and my family you would NEVER know what I go through on a day to day basis. It is difficult and frustrating, however, when I hear that I should just throw away the meds. I wish I were you, because you are one lucky person. Just be careful about judging the means that others must use to make it from one day to the next.

Sorry for the rant. I know you meant no offense.