CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

[echo]

Number 5?

So is this threat ahead or behind the legendary MOAT?

r

Most threats come from behind.

Although some swim up from deep beneath the moat.

[SleepingUgly]

Doesn't the search for the OSA "Magic Bullet" (the pharmacological treatment of obstructive sleep apnea) often include the use of SSRIs?

Might the discontinuation of fluoxetine create a whole new set of respiratory parameters?

Yes, which is what I was saying. The SSRI might be helping your sleep apnea to some degree. If your doctor looks at the raw data and concludes that your PLMS are true PLMS, with arousals, you might want to discuss switching medications. But maybe they aren't true PLMS, or they aren't causing arousals, then the question is how much it's helping the problem for which you were prescribed Prozac in the first place. If it is helping very much, and perhaps you even tried others that did not help, I would be reluctant to tamper with it until you've maximized everything else.

[dsm]

BB

Here is another thought to mull over (when in an arousal) - has this thread now become the cause of your destabilized sleep

Just wondering

DSM

[blizzardboy]

I have now discussed fluoxetine with two sleep doctors, a GP and my CBTherapist and none of them has shown the slightest interest in exploring me changing away from fluoxetine in the short term. So my conviction to make the change now is strongly challenged by those I pay to advise me (my advisors?)

I would respectfully submit that "not showing the slightest interest" and "strongly challenging" are two entirely different things.

p.s. you look vaguely familiar somehow...maybe its the moustache?

I dunno. You ever been to Singapore?

Hi NM, I agree that any one occurrence of "not showing the slightest interest" is insufficient impetus to generate a "strongly challenging" response. On the other hand, 4 occurrences creates a multiplying effect in my mind that then raises me to DEFCON "strongly challenging". But I accept your respectful submission and concede that I may be overly sensitive in my response to the apparent indifference to fluoxetine removal from the medical community to date.

"Doc, my sleep troubles are having a profoundly negative impact on my quality of life. For that reason, I was wondering if there would be any problem with my trying another SSRI just to see if that change could improve my sleep. Or is there some overriding medical principle that would make that a bad idea for some reason in my case?"

Hi jnk, Good call, but this is essentially what I have said to each medical professional. Given the relative recent progression in the treatment of both sleep disorders and mental health problems I feel that there is an overall lack of confidence to know what is the best course of action in my case. So, if they feel that fluoxetine is helping my anxiety/depression issues at the moment they are hesitant to experiment with change(s) without clinical evidence that I am likely to be better off. I think my best course of action is to wait and see what this new sleep doctor makes of my PSGs in six weeks time. I am going to come straight with my ceasing to take fluoxetine prior to these PSGs to get everything out in the open, as I can see now that I may have muddied the waters with potential SSRI withdrawal symptoms during my PSGs.

P.S. That's it NM, I saw you in Singapore back in 1996. You were chatting up a Cheese and Pumpkin Seeds at the ButterCup Bakery. Pity I was sick with a bout of Thai belly...

[blizzardboy]

I also see where Muffy suggested you could end up with all the Demons of Hell raining down on your head, too.

Thanks for adding that NM. I did think to balance the equation last night when I posted but ran out of puff. Of course, yes, Muffy has consistently highlighted the pros (e.g. improved sleep stability) and con (SSRI withdrawal) of moving away from fluoxetine (Prozac). Cheers,

[blizzardboy]

on the frequent awakenings, I just had that a few nights ago, right before a big interview. I was REALLY stressed out about it the few days beforehand. I went to bed at the normal time, even took a Sonata, and I woke up the whole night. Not merely "arousals" but full blown wake-ups, the WHOLE time. Finally got out of bed after 4 hours. I soooooo sympathize with you now.

I wonder how much of your mental stressors really are causing some of the nightly wake-ups... the adrenaline / cortisol created from the stress shouldn't be underestimated, perhaps. Have either of you had cortisol levels checked?

Hi echo, Thing is I am the most relaxed and easy going that I think I have been in many years. I am very stimulated by this sleep stuff, with my mind full of thoughts of all aspects raised in this thread, but I wouldn't say that I am stressed at present. On the hunt for answers, but not stressed. My family has been testifying to this fact! But, maybe you are right, maybe I still have a higher-than-usual cortisol level and this is contributing to my sleep instability. I can tell you that my adrenalin gland was working hard there for quite a few years. Thank goodness for a loving family, CBT, fluoxetine, wise counsel, and a good measure of grit and determination on my behalf!

I have just found out that my blood results are in. Unfortunately, due to a recent policy change, the clinic can not give them to me without an appointment to see a GP. So I have made an appointment today to get them. I will post a summary ASAP. Cheers,

[blizzardboy]

Congrats BB, you've created a monster

I hereby name this as the "Francis A. Johnson Memorial Thread". Please take a moment to meditate on this tribute to the great man: https://www.youtube.com/watch?v=yp9yqLbJ4Wk. Respect.

[blizzardboy]

Blizzardboy, I'm backlogged but still following your thread...

Hi -SWS, Good to hear you are still following. On 5/12/10 I began a fixed CPAP trial with P=9.6, set at the ASV EEP. My AHI was less than 5 last night and my mean minute ventilation was OK at 5.1 l/min: http://users.adam.com.au/sixsome/ASV/0510/051310/.

[blizzardboy]

And here are my blood results: http://users.adam.com.au/sixsome/bloods/. The GP thought that everything was fine.

As always, any comments or observations will be warmly received. Cheers,

[NotMuffy]

I have now discussed fluoxetine with two sleep doctors, a GP and my CBTherapist and none of them has shown the slightest interest in exploring me changing away from fluoxetine in the short term. So my conviction to make the change now is strongly challenged by those I pay to advise me (my advisors?)

I would respectfully submit that "not showing the slightest interest" and "strongly challenging" are two entirely different things.

Hi NM, I agree that any one occurrence of "not showing the slightest interest" is insufficient impetus to generate a "strongly challenging" response. On the other hand, 4 occurrences creates a multiplying effect in my mind that then raises me to DEFCON "strongly challenging". But I accept your respectful submission and concede that I may be overly sensitive in my response to the apparent indifference to fluoxetine removal from the medical community to date.

Of those four individuals, which is the one that originally ordered the fluoxetine?

NotMuffy

[NotMuffy]

p.s. you look vaguely familiar somehow...maybe its the moustache?

I dunno. You ever been to Singapore?

P.S. That's it NM, I saw you in Singapore back in 1996. You were chatting up a Cheese and Pumpkin Seeds at the ButterCup Bakery. Pity I was sick with a bout of Thai belly...

Nope, that wasn't me. I've never been to Singapore.

NotMuffy

[blizzardboy]

p.s. you look vaguely familiar somehow...maybe its the moustache?

I dunno. You ever been to Singapore?

P.S. That's it NM, I saw you in Singapore back in 1996. You were chatting up a Cheese and Pumpkin Seeds at the ButterCup Bakery. Pity I was sick with a bout of Thai belly...

Nope, that wasn't me. I've never been to Singapore.

[blizzardboy]

Of those four individuals, which is the one that originally ordered the fluoxetine?

The GP did it.

[NotMuffy]

Of those four individuals, which is the one that originally ordered the fluoxetine?

The GP did it.

Then I would further submit that it's your four Health Care Professionals that, when they hear you ask, "Hey, can I stop the 'Zack?" circle the wagons and go to Battle Stations.

The two sleep guys may not want to override the diagnosis and/or treatment of depression by the GP.
The GP may not wish to admit, "Hey, flox does all THAT?"
Weaning you off an SSRI can/will be a labor-intensive endeavor (for them as well as you).
If you really have a diagnosis of depression, risks of discontinuance can/will far outweigh benefits.
On my planet, CBT guys, for the most part, can't prescribe/discontinue medications anyway.
One/some/all of them may be unfamiliar with the PLM/OSA/sleep fragmentation/SSRI relationships, and "not showing interest" also "doesn't show unfamiliarity".
Those relationships are not well-defined anyway.
Generally, HCPs will not fix things that do not appear to be broken.

Reserving the right to insert more microanalysis of "not showing the slightest interest", including if they, in fact, really don't have the slightest interest, maybe that in itself is a worrisome problem.

NotMuffy

[blizzardboy]

Generally, HCPs will not fix things that do not appear to be broken.

I think that about sums it up: conservative, low-risk approach does it. I don't know what I am going to tell you this NM, given that I hardly even know you, but there is actually a third sleep doctor in my past, you know the one I originally encountered with the home PSG. This one suggested that if I got fit and increased my endorphin levels that I would be able to get off ADM. I was suspicious of this advice at the time. But maybe he made a valid point. Maybe physical exertion is an important part of healthy living. Maybe not maybe. Maybe definitely. I just wish physical exercise was a part of my subsistence, not a choice for well-being. How times have changed.