Still need some help...

[smiles2you]

Is this as good as it gets? Or should I see another doctor?
Any recommendations will be helpful!

I am a 42 year old mother of two (5 year old boy and 3 year old girl.) I was diagnosed with MOD OSA last summer and I have been using my BiPAP for almost a year now. I won't go into all the details, but it was really a 2 year quest for help with my symptoms of severe fatigue before I was referred for a sleep study. [One doctor told me my symptoms were "my body's way of telling me I needed to go back to work" as the "drudgery of being a SAHM was not my thing." LOL! Even when I brought up a sleep study with my current GP he said that I was "not a candidate because I don't snore and I am not obese." I am 5'10" and weigh 135."] But anyway, it was a long journey to get here. I am finally waking and feeling rested! I don't have morning headaches, which I always had attributed to allergies. I have my "get up and go." It is great. I am extremely compliant and use the BiPAP every night for 6 plus hours. In fact, my therapy hours for the past 30 days is 7:00. My current AHI is 2.7 for the past 7 days. My "sleep doctor" has declared my treatment a success and I agree for the most part. I am very thankful for the simple treatment CPAP offers for a medical dx that so greatly impacts function and quality of life!!! EXCEPT: I still have significant sleepiness between the hours of 1-5, everyday. Now that I am so far from that bone-crushing fatigue I felt when I began treatment, I can discern sleepiness/fatigue from a previously busy or stressful day, from this "sleepy spell." It feels like a warm blanket, or a tidal wave of sleepy hitting my head, and then I perk back up for the evening. I don't always HAVE to go to sleep and I can fight it, fight it, fight, but it is very effortful. My activities are definitely impacted. I am fussy and impatient during this time. It is terrible when I drive, and I avoid driving between these times if I have to go more than 30 minutes because I think it is dangerous. However with young kids, it will be more difficult to do this when school starts. I have seen my sleep doctor twice about this issue. He thinks it is due to the fact that I take 150mg of Effexor XR daily and recommends that I stop taking it. I have talked with the psychiatrist I see for medication management at least 3 times to discuss this. She absolutely doubts that the medication is causing my sleepiness and recommends that I continue the medication and see my GP. She also says that the sleepiness is "not a mental health issue." I don't think I am depressed, but the one thing that does make me feel down is the frustration I feel with the afternoon sleepiness when it is so hard to manage. I think I would be depressed without the med. I have been taking it for 8+ years and the depression/anxiety runs in my family.

Hey, I am in the prime of my life! I have young kids and things to do! I know it could all be worse, but I question if I should settle for this.
I have an appointment with my GP next week. I wonder if seeing a different sleep doctor for a second opinion would be worth the time and expense? Or should I see a different psychiatrist? I am certainly willing to try a different medication or wean off the current one (with a supportive doctor's assistance) if I can get some answers and help with the afternoon sleepiness first. Would it be unreasonable to have some type of medication assistance for my afternoons, while I try to wean off the Effexor and perhaps try a different med if I need it? Does anyone have experience with this? Once off, I could see if the afternoon sleepiness still persists? (BTW, I didn't know they even prescribed meds for EDS or that people could still have it with treated sleep apnea, except that during my last sleep Dr. appointment the respiratory therapist mentioned it! Frankly, the last thing I want is a different med I have to depend upon, but that is trumped by the desire to avoid recurrent depression and the longing to be totally functional and safe in the afternoon.)

OK, such a long post - my apologies - but I feel like I am at my wits end. How should I talk about this with my GP? (Oh, also, I have had all sorts of blood tests and seen an endocrinologist, but nothing abnormal was found. The Effexor is the only other med I take at this time, except for a multivitamin. I am active with my kids and swim almost everyday.) Thanks ahead of time for any assistance!

[Pugsy]

http://en.wikipedia.org/wiki/Venlafaxin ... de_effects

side effects (there are many) but this one is prominent.
Somnolence - 23% (9%

Somnolence (or "drowsiness") is a state of near-sleep, a strong desire for sleep.....

Wonder if you could reduce the dosage or alter when you take it to minimize potential effect.

That said. There can be other factors affecting how we feel the next day.
Fragmented sleep...pain..meds (you already know about this one)..mattress comfort. Any number of things.

My first suspect would be Effexor though.

[Slinky]

Welcome to the forum, Smiles2You. I really regret that I can't offer any suggestions or advice but I do wish you well and hope some of our other members can be more helpful than I have been.

[smiles2you]

Thanks!
I did try taking it at a different time of day - I forgot to mention that. I was first instructed to take it in the mornings because it can be "activating" so in May I took it at 6 in the evening as a test. There was absolutely no difference in the afternoon sleepiness, but it still could be the medication.

[robysue]

It's a shame the psychiatrist doesn't seem to think the Effexor XR could be causing the afternoon sleepies to hit every afternoon. Particularly since it is listed in the possible side effects at http://www.effexorxr.com/effexor-xr-saf ... 3016409913 (See the very last line of the last bullet item about "common side effects" that effected 10% of the patients in clinical trials.) Maybe you should bring in the Patient Information packet with the stuff about drowsiness highlighted for your psychiatrist to see it in print.

An pardon me for suggesting the obvious: Is it possible for you to take a nap yourself when the kids are down for their naps? With the BiPAP of course

And if you've tried this, does a nap for you when the kids are down for their nap help refresh you at all? Because an awful lot of moms with small kids take a nap at the same time as the kids to recharge their batteries too.

[smiles2you]

Thanks again for the suggestions! Robysue and Pugsy, you are quite right! Sleepiness is a listed side effect, why wouldn't it be for me?! I did more investigating and found an article about the effect of Effexor on sleep architecture and found it interesting.

The abstract summarizes:
The purpose was to examine the effect of the antidepressant drug venlafaxine on sleep architecture and periodic leg movements of sleep (PLMS) in normal volunteers. METHOD: Eight normal volunteers were studied under laboratory sleep conditions as follows: 1 acclimatization night, 1 baseline night, and 4 consecutive nights of venlafaxine p.o. administration (75 mg during the first 2 nights and 150 mg the last 2 nights). Venlafaxine increased both wake time and sleep stage I. Sleep stages II and III were reduced. REM sleep time was reduced after the first venlafaxine dose, and, by the fourth night, REM sleep was completely suppressed in all volunteers. Six of the eight volunteers showed PLMS at a frequency above 25 per hour. CONCLUSION: Venlafaxine produces several sleep disturbances, which include abnormal leg movements.
[Salin-Pascual R et al; J Clin Psychiatry 58(8): p.348-350 (1997)] **PEER REVIEWED**

Made me say "WOW!" That can't be good for you! How is it ok to give this medication to people?! (My study showed that I had a profound reduction of time spent in REM.)

I also found an archived post in the forum (thanks again!) about medication effects on sleep architecture, and it looked like every antidepressant had an effect!

SO, I am going to find a doctor to help me wean off the Effexor and just carefully monitor for any depression symptoms, be it my GP or another psychiatrist. Maybe not working so hard at night, since the apnea is better, will help protect me from a recurring depression?
*Has anyone found that success with CPAP has reduced or protected them from depression?
*Also, my Dr. says AHI<5 is success. Is that the general view? (Mine ranges from 2.5-3)

THANKS AGAIN! Wish I had found you guys when I was just starting!

PS - Robysue, I long for the afternoon naps with the kids. It does make so much sense and I did it when they were babies and toddlers! My 5 year old doesn't nap anymore and my 3 year old resists it all but a couple of days a week. They still have a "quiet, rest time" in their room everyday, and I use this for some down time myself. AND, since today is Saturday, my husband is home, and I am going to nap after I finish this post! My husband accuses me of sleeping my life away, but I say at least I don't need to sleep as much during the day as I used to.

[Pugsy]

Maybe not working so hard at night, since the apnea is better, will help protect me from a recurring depression?

Highly possible.

You know what the doctors diagnosed my morning headaches and fatigue as... anxiety/depression and post menopause crap and wanted to give me Valium.. which I took for a while and it didn't help. Just made me not care so much that I felt like crap.

Guess what improved markedly after about 6 months of effective cpap therapy? Yep. Along with the nighttime pee breaks my outlook on life improve tremendously.