Has CPAP Helped Your Mood?

[alpineartist]

Hi, Newbie here, just getting acquainted, and looking for a hand with some detective-work.

My hubby Ron (50 yrs old, 5’ 10”, 240 lbs, in good general health) has been on CPAP for about 9 months. Don’t have sleep study to post at the moment, but he was told that while he slept normally on his side, apnic events occurred while on his back. Dx: primary OSA with indications of CSA as well.

Symptoms pre-treatment:
• Un-refreshing sleep
• Arousals from 1-2 hrs per night
• Heart palpitations
• Morning anxiety
• Morning headache
• Depression-like symptoms

Other background:
No history of depression, life stress is normal. History of adolescent insomnia, possibly apnea related?
Breathes in short, shallow breaths during sleep (when I breathe in unison, I nearly hyperventilate)
Strenuous exercise 3-4 days/week.
Testosterone in normal range, adrenaline/ cortisol not yet tested.
Cardio/respiratory health is excellent, bp normal
Non-smoker, infrequent drinker, no prescription /illegal drugs
Altitude: 5400 ft, for 10 years

Now, to set up the subject at hand:
His adjustment to the apparatus has been relatively smooth & almost all symptoms have subsided. This is all very encouraging, and we are both extremely thankful!
However, the last symptom (depression) remains.
He describes the state as more like irritability: perpetually heightened adrenaline, blocking enjoyment.
While these symptoms can obviously originate elsewhere, he has the instinct that it is a remnant of his sleep-related issues. He notes that exercise relieves this symptom entirely for several hours.

Data:
• It appears that CSA is just one symptom of an autonomic nervous system glitch which also involves the Vagus nerve. This nerve regulates breathing (and is, inversely, somewhat affected by breathing.)
• The Vagus nerve, it is also found, has some effect on mood. When stimulated in some subjects, marked relief from depression is noted.
• I’ve also read that Vagus nerve stimulation interferes with CPAP use and that before initiating Vagus nerve stimulation therapy, sleep apnea patients should be identified.
• I also read that some depression/anxiety patients, when trained to breathe differently, find great relief, possibly due to Vagus nerve stimulation.
(Please forgive me if this is nothing new to the board - links available)


Conclusions:
CPAP is an effective treatment for relief of hypoxia symptoms. But remaining symptoms of mood, mental acuity, hearing, etc. seem to stem from neurological causes, and should be addressed separately.
In fact, the same causes may be responsible for CSA.


Questions:
If CPAP therapy for OSA sometimes causes CSA, is it because CPAP-altered breathing affects the Vagus nerve or other breathing drivers in the brain? Is there a more highly-calibrated CPAP for CSA to fix that?

As CPAP users, have you had mood symptoms like those above?

If so, have you noticed that CPAP therapy alone addresses them, given long enough?

Any other clues or pieces to the mood puzzle?

Thank you in advance for your help!

[jnk]

Does his machine give efficacy data and leak data?

Here is my gut reaction as a fellow patient:

Some with a persistent CSA component to their sleep-breathing problems (perhaps especially so at higher altitudes) may end up needing ASV to get the best sleep. Or not. But it is good to be aware of those special machines for dealing with some aspects of some forms of CSA.

Also, years of sleep troubles can leave us with residual sleep issues that may have been initiated by, but on another level are basically unrelated to, OSA. Meticulously good sleep hygiene for several weeks can help offset that. Most of us need sleep-hygiene work in conjunction with out PAP therapy to feel our best during the day. The results of years of bad sleep just don't go away overnight.

Keep your sleep doc in the loop, since he may have to document things now in order to be able to prove the need to try ASV at some point in the future.

If the mood is responsive to exercise and sleep hygiene and other lifestyle-type adjustments, pursuing that while looking into whether the CSA has resolved may be you and your doc's choice for now. But, naturally, not all mood issues are sleep or sleep-breathing related. Many aspects of our daily lives come into play with that one. PAP therapy may give us more energy, but how we choose to invest that energy has a lot to do with what the mood payoffs and overall-health payoffs will be down the road. The mood-expert docs can have useful info customized for our exact situaion, and some will give it without locking you into a 50-minute visit every week.

[Todzo]

Hi, Newbie here, just getting acquainted, and looking for a hand with some detective-work.

My hubby Ron (50 yrs old, 5’ 10”, 240 lbs, in good general health) has been on CPAP for about 9 months. Don’t have sleep study to post at the moment, but he was told that while he slept normally on his side, apnic events occurred while on his back. Dx: primary OSA with indications of CSA as well.

Data:
• It appears that CSA is just one symptom of an autonomic nervous system glitch which also involves the Vagus nerve. This nerve regulates breathing (and is, inversely, somewhat affected by breathing.)
• The Vagus nerve, it is also found, has some effect on mood. When stimulated in some subjects, marked relief from depression is noted.
• I’ve also read that Vagus nerve stimulation interferes with CPAP use and that before initiating Vagus nerve stimulation therapy, sleep apnea patients should be identified.
• I also read that some depression/anxiety patients, when trained to breathe differently, find great relief, possibly due to Vagus nerve stimulation.
(Please forgive me if this is nothing new to the board - links available)

Hi alpineartist!

A couple of questions for you. Is your husband diagnosed with a vagus nerve problem? Is your husband using a vagus nerve stimulator?

Thanks!

Todzo

[retrodave15]

Men do not always show the "normal" depression symptoms. We get grumpy, irritable, and figure it will just go away since we are the "Strong Ones."

I have depression, ADHD, and had many of the same symptoms of frequent arousals, poor sleep, palpitations, anxiety and even chest pain at times. Treating my OSA made these more manageable, but did not make them go away.

I made the choice to seek out mental health treatment, something I wish I had done year's ago. Except for my neck issues - I feel better than I have in years.

[Suddenly Worn Out]

Dont know much about the vagus nerve, although I know that stimulating it with an implant has been experimentally tried to treat both depression and anxiety. I dont know if Vagus Nerve Stimulation ever got to FDA approval for depression and anxiety or not though.

I can definitively tell you that CPAP has helped my mood and my anxiety problems. And if I dont use my CPAP for even one night, or if my pressure is too low, my mood is bad the next day. There is a definite cause/effect relationship between the quality of your sleep and the quality of your mood. No doubt about it.

My mood is better on higher pressures, but my stomach cannot tolerate the higher pressures.

As far as triggering centrals, I dont know much about them. I have heard centrals can be caused by a multitude of things, heart problems, neurological problems, all sorts of things. This is the first time Ive read somewhere the vagus nerve might be involved in tripping central apneas. I dont discount your claim or idea, but just know nothing about it.

I would think a Neurologist trained sleep medicine doctor would be a good candidate to tell you the answer to your question. As the vagus nerve is well, a huge nerve and neuros are the nervous system experts.

Also, another thing to think about. If you are using a higher end machine, you dont have to worry about centrals much unless the CSA is bad. Which if that is so, your sleep med doc should be following through on about the CSA problem, if that is a problem. But the high end Resmed S9 series CPAPs and APAPs and the Respironics high end APAPs and both Resmed and Respironics Bipaps detect central apneas and respond accordingly. If the machine is an older machine or a lower end model it probably does nothing to detect or handle csa.

I always heard if centrals are a major issue, switching to a Bipap is often the direction to go.

Bottom line though, YES, CPAP has made it so I no longer seriously think about suicide much anymore. And when I still do think about suicide once in a while, the thoughts are not very strong and do not last very long. Before CPAP I had chronic suicidal thoughts and was always in a depressed, irritable and hazed out mental condition. I have wondered how many "depressed" people are out there on medications and are just sliding by, when they also need CPAP added onto their medication regimen. I would bet it is a lot of psychiatry patients.

Eric

[archangle]

When I was really sick from having my CPAP machine set too low, I got into a cycle of just lying around doing nothing all day because I was simply too worn out.

After I fixed my pressure settings and my energy level improved, I sort of stayed stuck in the rut, in part because I had gotten so used to just moping around all the time because I had no energy. I had to consciously tell myself "hey, you're feeling good. Let's go do something."

Of course, that doesn't work for everyone.

[purple]

Based upon what u wrote. I would guess that you have already considered everything I might say, but to be helpful.

If the heart palpitations r still present, then that is a crucial get something done now. With an episode of heart palpitation, the heart can flip a clot, which might go to the brain, heart, or somewhere it does a bunch of damage. The heart might not get back into regular rhythm on its own, which could of course be fatal. Quite often the palpitation can be treated by a drug, and it does not have a lot of side effects.

You did not mention blood sugar, which surely the doc checked for Diabetes. Diabetes often comes with depression attached. Diabetics can be the most loving of people, but turn mean grumpy when their blood sugar goes out of whack. Whatever it is that keeps our brain from saying hurtful, angry things gets turned off by the Diabetes.

One of my friends wife told me that her husband liked to grump, but he mainly grumped at people he liked.

Getting rid of diabetes might not get rid of the depression, as one can have built up a habit of "stinkin thinking." The consequence of untreated diabetes is earlier than usual heart problems, blindness. amputation of limbs. low energy, and while sometimes the beginning is a big abdomen. (and a big abdomen is does not mean one has diabetes, but a lot of diabetics have the big abdomen)

[apsews]

I am just two weeks into cpap therapy and so far I think my depression is better. I won't know for sure till a few months have past but at this point I am hopeful to be able to come off my depression meds(with the help of my GP) in the not too far future and before starting cpap I wouldn't have given it a second thought(thought I would never live without it). Being here and hearing all the success stories have really given me some much needed hope. Thanks for all that you all do!!
I am not much help for you but just wanted to share.

[NeNeen]

Getting rid of diabetes might not get rid of the depression, as one can have built up a habit of "stinkin thinking." The consequence of untreated diabetes is earlier than usual heart problems, blindness. amputation of limbs. low energy, and while sometimes the beginning is a big abdomen. (and a big abdomen is does not mean one has diabetes, but a lot of diabetics have the big abdomen)

There is no such thing as "Getting rid of diabetes".

One can get it under control thereby reducing any signs of depression or tiredness.

In the three weeks I have been on my CPAP I am finding I have more energy and in a better mood. I am diabetic as well as bipolar and take medications for both. If my mood continues to improve perhaps I will be able to reduce my mediation dosage with the doctor's advice.

[purple]

There is no such thing as "Getting rid of diabetes".

Good point. I stand corrected. I meant to get one's blood sugar under some control. Altho, I have was borderline diabetic for a long time with no medication, because I was more careful with what I ate and the amount of exercise. I might not have the high fasting sugar which has been used to diagnose diabetes, and not take medicine, but my doc might still say I had diabetes because of previous high blood sugars. and the rate my blood sugar rises after ingesting a normal meal.

Some diabetics have a slang, like, "I got that sugar disease." Which does require a bit of translation.

[lazer]

Just to add. I've noticed the more physical improvements since being on pap, however, the emotional issues still exist and unfortunately I have to be reliant on my meds for that at this point.

[chunkyfrog]

Sometimes it is even simpler:
I could feel the adrenaline pumping through me before CPAP.
I was WIRED --all day.
After CPAP, I even missed it for a while.
Is it possible to be addicted to your own stress hormones?

[jnk]

. . . Is it possible to be addicted to your own stress hormones?

One school of thought is that it is possible to become addicted to anything.

As for the direct question, I don't know any bungee jumpers who do it for their health.

As for the point you make, I think it is one of the most amazingly prescient points I've read in a while. I think successful PAP users do well to invest in higher levels of activity and higher levels of human engagement in order to make up for the extra abilities they acquire, or else the benefits of PAP can easily go to waste or can easily get turned against us, in a manner of speaking.

[SleepyToo2]

Exercise is good for your body, regardless of weight change. Getting the blood moving faster is going to be good for the brain, too. Reducing levels of hypoxia may have somewhat similar effects, allowing someone with depression to reduce their medications (with physician approval, of course). As has been pointed out, depression is caused by many things. Untreated sleep apnea (or maybe inadequately treated) could certainly be one factor. Proper treatment may result in an improvement in mood. Whatever the cause and effect, I know that I am much happier now that I have got my AHI down to around 1.

[Todzo]

Sometimes it is even simpler:
I could feel the adrenaline pumping through me before CPAP.
I was WIRED --all day.
After CPAP, I even missed it for a while.
Is it possible to be addicted to your own stress hormones?

Hi chunkyfrog!

"Is it possible to be addicted to your own stress hormones?"

Are you kidding! For you chunkyfrog:

http://www.grindtv.com/outdoor/blog/351 ... reathless/

Have a great week!

Todzo