A Couple of Questions

[Pugsy]

You say exhaustion and you say sleepiness. Is it one or both? They aren't necessarily the same.

What meds are you on for depression? Have you researched them yourself to see what side effects there might be?

[Otter]

My psychiatrist says that the meds I'm on for depression don't cause sleepiness.. and I don't think any changes in them have coincided with changes in how I feel (I've been VERY tired for the past couple of months).

Pugsy is right, sleepiness and tiredness are two different things.

Maybe you don't need titration, but a sleep study might show that something is interfering with your sleep. Just because you sleep a lot and your apnea is well treated doesn't mean you're getting the REM sleep you need.

How much exercise do you get?

[Telle]

You say exhaustion and you say sleepiness. Is it one or both? They aren't necessarily the same.

What meds are you on for depression? Have you researched them yourself to see what side effects there might be?

I'm not sure what the difference is? I have a lot of trouble getting out of bed each morning. On the weekends I often nap more than once. On weekdays I'm nodding off at my desk, and falling asleep on the couch at 7pm. I'm just tired all the time and constantly feel like I could sleep more.

I'm on Abilify and Cymbalta. I haven't gotten around to researching them for myself yet.. at least not on this (I am trying to conceive so I did research quite a bit about their safety in pregnancy, despite my psychiatrist reassuring me).

[Telle]

My psychiatrist says that the meds I'm on for depression don't cause sleepiness.. and I don't think any changes in them have coincided with changes in how I feel (I've been VERY tired for the past couple of months).

Pugsy is right, sleepiness and tiredness are two different things.

Maybe you don't need titration, but a sleep study might show that something is interfering with your sleep. Just because you sleep a lot and your apnea is well treated doesn't mean you're getting the REM sleep you need.

How much exercise do you get?

I did think of that this morning.. even though I'm not having trouble from my apnea, I could still be having arousals or not getting REM sleep. So doing the re-titration might be a good idea regardless.

Unfortunately I'm not getting much exercise at all right now. I've recently started having a horrible pain in my left calf when I walk. I went to the doctor and they checked it out and found it is not a blood clot, which was the concern, but I still don't know what the problem is or if it's going to go away or what. I used to walk 3-4 times a week for about a half an hour, and that hadn't changed during the period in which I started having trouble with wanting to sleep all the time. It's only been a couple of weeks now that I haven't been able to walk much anymore.

[Pugsy]

I'm on Abilify and Cymbalta. I haven't gotten around to researching them for myself yet..

Most of these types of drugs cause drowsiness and tiredness. I would have been surprised if the side effects didn't list what I found.

Here is Cymbaltas side effects. Note tiredness, weakness and drowsiness among many others.
http://www.ncbi.nlm.nih.gov/pubmedhealt ... ideEffects


Here is Abilify. I see drowsiness among others.
http://www.ncbi.nlm.nih.gov/pubmedhealt ... ideEffects

While these meds alone may not be the only factors in your exhaustion and sleepiness...they sure could be making it worse. Problem is damned if you take them and damned if you don't.
I don't know the half life of these meds nor when you take them nor dosage but if it were me I would be discussing it with my doctor (not the psychiatrist who obviously didn't bother to look up the side effects) to see what can be done to limit potential unwanted side effects.

One other thought. You mention that you are trying to conceive. I assume that this has added a bit of stress to your life. Stress itself can be exhausting and of course potentially make depression worse.

[Otter]

I'm not sure what the difference is? I have a lot of trouble getting out of bed each morning. On the weekends I often nap more than once. On weekdays I'm nodding off at my desk, and falling asleep on the couch at 7pm. I'm just tired all the time and constantly feel like I could sleep more.

Tiredness and exhaustion have to do with your need for sleep and other restorative processes. Sleepiness is the result of melatonin, the hormone that puts you to sleep. It's possible to be dead tired and not be sleepy. Insomnia will do that to you.

Though it's not as common, you can also be sleepy without being tired. One situation where this might happen is if you fly from San Francisco to London. You get to your hotel at midnight, but it's only 4pm in California, and you napped on the plane. You're not tired, but if you don't get some sleep, the jet lag will be brutal the next day, so you take a melatonin tablet to make yourself sleepy. You're still not tired, but the pill makes you sleepy and you nod off for a couple hours.

It sounds like you are both tired and sleepy, and that's much better than just being tired.

[Telle]

Well if it's the meds, then I guess I just have to get used to being tired all the time. I am seriously NOT in a good place when not on them. I tried weaning off of them before we started trying to conceive.. and things did not go well. And thinking back to the days before I was on the meds.. yeah, not pretty.

As far as stress goes.. it could be a factor, but not from trying to conceive. We already have two wonderful children and so if it doesn't happen it's not the end of the world. There are definitely days in which it bugs me that it's been over two years now with no success.. but for the most part it doesn't effect my day-to-day stress level. My job, however, I find very stressful. And the odd thing is that this is because I'm so freaking bored! I don't have enough work to keep me fully occupied.. and it drives me nuts having to try to find things to fill my day. So maybe that has something to do with it.. I dunno.

[Pugsy]

Well if it's the meds, then I guess I just have to get used to being tired all the time. I am seriously NOT in a good place when not on them.

I understand. That is why I said damned if you do and damned if you don't. It may help mentally to know that the meds are a potential factor in your fatigue or it may make it worse. At least you have a viable explanation.
I don't know the half life of those meds. Do you take them in the AM or PM? Perhaps a change in time of dose will help.

[Telle]

I take the meds in the morning. However, I'm still tired upon waking in the morning and just desperately want to stay in bed and sleep more at that point.. so if the tiredness is from the meds, it doesn't wear off within 24 hours. So I don't think that changing the time I take them is going to make any difference.

[Pugsy]

When you are bored you might try to find out half life of the meds and also if the use of them messes with sleep architecture. You might also take a look at your sleep study reports to see if normal sleep architecture was present.
Meaning the normal cycles and the amount of time spent in each cycle. I think it is N3 stage and REM where most of the restorative powers come from. If time spent in those stages is reduced it can also mess with how we feel the next day.
Just a thought outside the box.

[Marcman]

Hey Telle,

I just wanted to throw in here that I'm going through something kind of similar. I don't have any answers, but maybe it's nice to know that you're not alone.

I take Zoloft for depression (in the evening because it seems easier for me to remember to take it then). I've been on CPAP for almost a year. My AHI is usually below 3 and my leaks are under control. I still wake up pretty tired and I'm very tired most of the day and have memory, concentration, and attention problems.

After watching Dr. Steven Park's most recent teleseminar where he talked about other things that could cause problems even if your AHI is low, I'm doing a bit of surfing on UARS and I've scheduled an appointment with my sleep doctor again to see what he can do. If that doesn't help, I'm going to see another sleep doctor. I'm not giving up.

[BlackSpinner]

Well if it's the meds, then I guess I just have to get used to being tired all the time. I am seriously NOT in a good place when not on them. I tried weaning off of them before we started trying to conceive.. and things did not go well. And thinking back to the days before I was on the meds.. yeah, not pretty.

However - untreated sleep apnea can cause depression, anxiety and other emotional issues so you may want to consider reducing these meds WITH the help of your doctors. It is possible that by treating your sleep apnea you are now treating the underlying causes.

Also many people have found that by treating their sleep apnea their medications work stronger. For example caffeine now has me totally wired if I drink it after 11 am.

[Telle]

However - untreated sleep apnea can cause depression, anxiety and other emotional issues so you may want to consider reducing these meds WITH the help of your doctors. It is possible that by treating your sleep apnea you are now treating the underlying causes.

Also many people have found that by treating their sleep apnea their medications work stronger. For example caffeine now has me totally wired if I drink it after 11 am.

That would make sense.. except I've been on the CPAP since last summer (for some reason I thought it was October, but when I looked at my data last night it said late June, and now I'm starting to remember that as right).. and I had a bad spell with the depression in November even while on the meds. We actually upped the Abilify a little after that and switched from Effexor to Cymbalta.

[Telle]

Thanks for posting Marcman. It is good to know that I'm not alone in this. I'm just not really sure as to what to do about it anymore. I jumped at the chance for a re-titration in the desperate hope that it would be the answer.

The good news is that I haven't had to fight nodding off at my desk yet today.. so that's something It's generally a daily occurrence for me lately, which is really frustrating.

[Alshain]

That's why I started looking at my AHI and leak rate data again. However, I don't have the software to look at everything in detail for the course of the night.

You can download Resmed's software for free here:
http://www.resmed.com/int/assets/html/s ... c=patients

Or, if you're feeling adventurous, try Sleepyhead 0.8 alpha.
http://sourceforge.net/projects/sleepyh ... s/Testing/

viewtopic.php?f=1&t=65738&st=0&sk=t&sd= ... sleepyhead

Sleepyhead works with ResMed? It thought it was just for Philips.