Increased Daytime Anxiety and Depression

Hello,

I was diagnosed with sleep apnea and my AHI was 57. I have been using the CPAP machine for 24 days straight. I am
Now averaging an AHI under 3.0. I feel more energetic however, my daytime anxiety has ramped up significantly and my OCD is almost uncontrollable.

Everything was fine prior to CPAP therapy. Here are my questions:

(1) Is this a common occurrence?
(2) Is these a link between the anxiety and CPAP therapy or is coincidental?
(3) Has anyone else experienced this ?

Any advice or guidance would be greatly appreciated because I am on the verge of discontinuing CPAP therapy.

Here is but one take (mine) on that fairly commonly reported phenomenon:

With that high of an AHI, your body may in the past have been manufacturing a lot of "extra" hormones to have on hand to jar you awake all night whenever you stopped breathing. Once the airway is being effectively kept open all night with positive airway pressure, the body/brain takes a while to figure out it doesn't need that much on hand anymore. So for a while, it looks for any opportunity during the day to burn some of that off with some manufactured anxiety/panic.

The tiredness of bad sleep can, in a sense, mask anxiety for the untreated. But the answer to the temporary surplus of hormones shouldn't be deciding to return to bad sleep. Strap in and hold on for the ride as the body gets used to the healthy temporary side-effects of getting sufficient consolidated sleep every night. If you always sleep with your mask on, that will help the adaptive process of your body and brain figuring out that the mask and pressure are good things that are helping, so that the body and brain can, eventually, relax.

Not all docs are informed about the emotional and mental bumpy road some of us experience with improving our overall health with PAP therapy. Some of us have tarmacs and runways that are more pot-holed than others just before all the full benefits of PAP take flight. Nevertheless, don't keep your medical team in the dark about what you are going through if it is more than a mere annoyance to you.

Stress is stress, and doing things to improve our health can be very stressful in their own unique ways. That doesn't make them bad, but it can make change, even positive change, difficult. Add to that the fact that our senses are sharpened, less dulled, with good sleep, and many of us find we experience our emotions more vividly, especially at first. Fatigue and sleepiness can mask the vividness of our experiences, but that is never a reason to choose fatique and sleepiness over our experiencing reality. Don't abandon healthy habits such as always using PAP for all sleep.

Upping your daily exercise game, especially early in the morning, can help to alleviate some of the extra-hormone issues, if your medical team signs off on that.

Sorry for the long post.

I wish you all the best.

-Jeff

Oldmanstrong wrote: ↑

Mon Aug 25, 2025 8:51 am

Any advice or guidance would be greatly appreciated because I am on the verge of discontinuing CPAP therapy.

Basic advice: Make sure your life insurance premiums are paid before you go back to an AHI of 57 and give up on an AHI of 3.

Which medications, dosages, and timings do you use?

Do you practice good sleep hygiene vis-à-vis diet, consistent bed times, moderate exercise, limited caffeine with none in the afternoon?

Jeff, thank you very much for the detailed post. What you are saying makes sense to me because I was doing very well prior to CPAP therapy and then out of the blue, my symptoms reappeared. I have just only now have become accustomed to wearing the mask every night, so quitting now would be nonsensical (Especially as my sleep apnea is well controlled). As you indicated, my body/brain are probably just adjusting to the increased in quality sleep. What is frustrating to me is I lift weights 5 days per week, I practice good sleep hygiene, and I take my meds religiously only for the symptoms to creep back. On a positive note, I can tell you that my weight training went to the next after a week on CPAP therapy.

ChicagoGranny: I currently take 2 mg of Rexulti, 100mg of Zoloft and 40 mg of Viibryd. I eat a well-balanced diet (higher in protein and moderate on carbs). I do not consume caffeine after 10:00am. Prior to the CPAP therapy, my symptoms were very well controlled, but they came raging back with a vengeance about a week ago. I will stay the course and continue with CPAP therapy it's just that I am frustrated.

Significant changes in sleep patterns can at times be a good reason to take a fresh look at all forms of med dosing--of course doing so at the right pace in cooperation with, and taking full advantage of, the assistance from one's medical team, not simply on one's own.

But you know that. I'm just stating that so pedantically here for any lurking readers in similar circumstances.

Some have found that cardio is more the key to constructively burning off excess panic juice.

Your frustration is completely understandable. May you successfully find your way through it as many others have.

Oldmanstrong wrote: ↑

Mon Aug 25, 2025 12:36 pm

2 mg of Rexulti, 100mg of Zoloft and 40 mg of Viibryd

Zoloft and Viibryd are well known to cause sleep problems.

You started taking all three of those drugs while you were undiagnosed/untreated for sleep apnea. The symptoms that cause you to start taking them could have merely been symptoms of untreated sleep apnea. It would be a good idea to talk with a doctor about slowly tapering down.

I just wanted to post an update on my increased anxiety and depression when i started CPAP therapy.

I had an appointment with my psychiatrist. She told me she was not an expert in CPAP therapy but she would look into my new symptoms vis-à-vis CPAP therapy. In the meantime, she prescribed 50mg of Trazadone. It has been absolute game changer! I sleep through the night and I wake up refreshed and ready to meet the day.

I suspect I might have had some nighttime anxiety and CPAP adjustment issues. The Trazadone (which also acts as a sedative) must have rectified both conditions.

I was on trazadone for many years. I like that it is an antidepressant w/sedating effects. It is an old 'work horse' without all the bells and whistles that the newer drugs that have lots of advertising money to spend. Also, it is not addicting. Glad to hear this helped so much. And no, I'm not a sales rep for trazadone - it just helped me enormously.

I was very hesitant to take ANOTHER medication but to your point, Trazadone seems to be different. It has helped tremendously in a very short period of time. Thank you for the support

Oldmanstrong wrote: ↑

Mon Sep 01, 2025 11:43 am

psychiatrist

Psychiatrists need to have drilled into their brains the knowledge that untreated sleep apnea can destroy mental health, and that the prevalence in the population is high. The prevalence among people who show up at psychiatrits' doors is even higher. No psych drug should ever be prescribed until the patient has been screened for sleep apnea.

No physician should ever refer a patient to a psychiatrist or mental health professional until a screening for sleep apnea has been completed.