Remedy for Sleep Apnea May Lift Depression's Veil

[coffee]

http://www.nytimes.com/2005/09/20/healt ... sleep.html

The New York Times
September 20, 2005
Remedy for Sleep Apnea May Lift Depression's Veil
By NICHOLAS BAKALAR

Fatigue, irritability, lack of concentration and loss of interest in enjoyable activities are common symptoms of depression. But they are also symptoms of obstructive sleep apnea, and a new study suggests that physicians may confuse the two.

The findings, published in the September issue of the journal Chest, reports that many patients with depression symptoms improved markedly when treated with continuous positive airway pressure, or CPAP (pronounced SEE-pap) therapy, the standard treatment for sleep apnea.

This finding does not necessarily apply to all patients with depression, said Dr. Daniel J. Schwartz, the lead author on the study and director of the Sleep Center at University Community Hospital in Tampa, Fla.

And, Dr. Schwartz said, not everyone who has depression symptoms should automatically be evaluated for a sleep disorder.

"But they perhaps should speak with their physicians about symptoms which might be suggestive of obstructive sleep apnea," he said.

The disorder, often referred to as O.S.A., occurs when the tongue or throat muscles relax too much during sleep and block the airway. This can happen more than 50 times an hour during sleep, causing snoring and pauses in breathing that last as long as 60 seconds.

The problem is twice as common in men, and it afflicts more than 12 million Americans, according to the National Institutes of Health.

Sleep apnea is usually treated by wearing a mask or using a specially designed nasal device that delivers air under slight pressure, keeping the airway open so that the patient can breathe normally.

Dr. Eric Hollander, professor of psychiatry at Mount Sinai in New York, found the results intriguing. "It might be a real effect on the emotional and physiological symptoms of depression," he said, "and the effect seemed to be pretty robust."

The researchers studied 50 men and women admitted to the Tampa sleep center. Each was administered a commonly used psychological screening questionnaire, and 41 showed some signs, either marked or mild, of clinical depression.

Nineteen participants had been receiving antidepressant medication for at least two months at the time of referral.

After receiving treatment for sleep apnea for four to six weeks, 40 of the 41 participants taking antidepressants and those not taking them showed decreases in their depression scores.

They also showed marked improvement in measures of daytime sleepiness.

Dr. Steven P. Roose, professor of clinical psychiatry at Columbia University, minimized the importance of the findings.

He said the scores on the questionnaire administered at the outset of the study suggested that these patients were not truly clinically depressed to begin with.

"Essentially," he said, "the study shows that people who are really not depressed before are really not depressed after" treatment for obstructive sleep apnea.

Although the authors assert that their findings strongly support the potential for CPAP to improve the symptoms of depression, they acknowledge that their study has certain limitations.

They did not strictly monitor the treatment, and they concede that the questionnaire they used was designed as a screening tool for depression, not for measuring changes in symptoms. They add that they cannot rule out the possibility of a placebo effect from the treatment.

Some participants in the study were probably simply misdiagnosed with depression, the researchers concluded, but they pointed out that the misdiagnosis was not always the problem.

It may be that the underlying mechanisms of depression and sleep apnea are the same, or that obstructive sleep apnea is itself a cause of depression.

The apnea and the depression may simply tend to occur together, Dr. Schwartz said, or there may be "a more complex interaction with one entity contributing to the development of the other."

"I regret to say that as yet the answer eludes us," he said.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

[Oh 2 breathe]

Thanks for printing this article.

I work as a counsellor in a community mental health program. There is a significant overlap of symptoms between depression and sleep apnea, and if a doctor is not well-informed or has only 5 minutes to assess and move the patient on, there is a very high potential for misdiagnosis. At the same time, if a person is suffering long enough from sleep and oxygen deprivation they can well become very depressed and irritable.

In my own experience I thought I was suffering from job burnout symptoms. I don't fit the typical profile for sleep apnea and I work in a field considered high stress, so it got missed for quite some time. At one point my doctor asked me if I was depressed, and I replied that I am fatigued and my bones ache a lot but that I didn't really feel depressed or sad. He ordered a whole bunch of blood work, an ultrasound and an MRI trying to figure out what was wrong with me. At the same time I was also actively searching for health information about what it could be. I finally came accross a checklist of symptoms for sleep apnea and found I had most of the symptoms on the list. I then took this to my doctor, who then referred me to a sleep lab where they confirmed the diagnosis. Had I not obtained the information to diagnose myself, I might never have gotten the CPAP therapy I needed.

Since this experience I now make a point of asking people about their sleep quality and if there seems to be the possibility of a sleep disorder I send them back to their doctors to request an assessment at a sleep lab.

I wish doctors were better trained and the general public could be made more aware of this very common disorder. It would save a lot of lives.

~ 02B

[rested gal]

Had I not obtained the information to diagnose myself, I might never have gotten the CPAP therapy I needed.

and

I wish doctors were better trained and the general public could be made more aware of this very common disorder. It would save a lot of lives.

O2B, your words are right on target!

[snowloft]

Excellent article! For the past 4 weeks since I started using CPAP, I have stopped taking antidepressents because I no longer feel depressed. They may have something there!

[LoneRider]

Thanks for printing this article.

Same, and, it would also be useful to post the URL to the article if available as well. Covers the copyright information and may be useful for further research on our part.

Since this experience I now make a point of asking people about their sleep quality and if there seems to be the possibility of a sleep disorder I send them back to their doctors to request an assessment at a sleep lab.

Aiy, as I've said before, I have to thank Bill (waflowers), if not for reading his experiences Stacy and I might not have mentioned some of my other symptoms to the doctor. I am pretty much a "if blood ain't squiring out it ain't broke kinda guy". But I did mention to the doctor about needing a nap every day, and after another 2 minutes of conversation he was prescribing a sleep study.

To the point, I was just talking to a friend here at work, and we got talking about his Dad, naps often, snores like crazy, large neck, high BP, diabetes, over weight and some depression. Hmmm, could it be OSA?? My friend does not know a lot about CSA and OSA and I told him a bit, and discussed some of the problems. I mention that with his Dads existing BP and some heart problems (enlarged heart) he probably has a good risk of passing away in his sleep. My friend kinda went pale ..... His Mom constantly tries to get his Dad to the doctors office with no luck.

I wish doctors were better trained and the general public could be made more aware of this very common disorder. It would save a lot of lives.

In polite company, all I will say is I complete agree with you!


cheers,
Tom

[WAFlowers]

To the point, I was just talking to a friend here at work, and we got talking about his Dad, naps often, snores like crazy, large neck, high BP, diabetes, over weight and some depression. Hmmm, could it be OSA?? My friend does not know a lot about CSA and OSA and I told him a bit, and discussed some of the problems. I mention that with his Dads existing BP and some heart problems (enlarged heart) he probably has a good risk of passing away in his sleep. My friend kinda went pale ..... His Mom constantly tries to get his Dad to the doctors office with no luck.

Tom, feel free to forward some of those emails I sent to your friend at work. Maybe what I found out about me (and that is helping you and another friend here and maybe my brother-in-law) can help others. Be sure to add info on the cardiac implications of sleep apnea which I didn't include as they didn't apply to me, but likely do to your friend's Dad.

[Patrick A]

Boy that hits home, since I have been using CPAP Machine my Glucose levels have almost dropped to normal averaging 90 to 140.

[Carlton]

Can really relate to what you guys are saying. Diagnosed with depression myself Doctor never even asked if i snored before dishing out the pills. Never had that many depression symptoms anyway cept for the tired all the time bit. Anyway been on CPAP a week now and feeling exactly the same way as i did first few weeks on the pills (not that great but think this must be promising)