A psychiatrist thinks an OSA patient has also hypochondria

49er wrote:Hi Hydraulix989,

Welcome to the forum.

Regarding RERAS, making the comparison between what they show after using the machine and a sleep study that shows the figure when it is untreated is not a valid comparison.

Thank you! I agree, and as you know, sleep studies can be performed both, not only without, but also WITH the machine (cf. "split night" studies and titration studies), and so PSG+PAP data can be more fairly and directly compared with the PAP data.

Regardless, CPAP machines don't and CAN'T score RERAs by themselves, by definition; the name is deceptively misused in PAP data. It's definitely not an honest representation of what the PAP machine is measuring at all.

49er wrote:Regarding taking an SSRI, you are aware that many times, they cause insomnia right?

Hm, I never experienced this first hand -- quite the contrary, I have to take my SSRI at night, or I will fall asleep during the day. I realize that this is personal experience, and if you do experience insomnia as a side effect (which DOES appear to be pretty common), then of course, you should disregard my advice. I don't even think medical science has fully caught up with understanding who is likely at risk for the various side effects and contraindications of SSRI use.

I'd also listen carefully to Sy. Park's advice. Some comments:

1.) Yes, that "10-second rule" is rather arbitrary, much like the often-cited 5 AHI cut-off for a sleep apnea diagnosis. In software engineering, we call these "magic numbers." The in-joke is that there actually isn't anything "magical" about them.

2.) A CBC would be enough to rule this one out, no? One of the best doctors I've ever seen ran a few specific "rare, but high signal" blood tests on me to rule out these possibilities.

3 and 4.) Agreed!!!

5.) MMA is last resort for me personally, but curious what percentage "doesn't feel better" (even an estimate is okay)? I feel like the literature still really hasn't caught up yet with measuring MMA outcomes, let alone identifying the best candidates for surgery.

6.) CBT still feels like a "band-aid fix" to me.

7.) If you're going to get your "evaluated," make sure you see a top-tier ENT. Depending on who you see and what their experience is, you might hear all sorts of blatant mis-information; the variance is all over the place: If they suggest doing a UPPP, RUN!!! and find someone else!

Also don't obsess too much on the < 1 AHI data reports coming from your CPAP -- they are almost completely useless compared to a real PSG. Of course, you still feel tired if you're tossing and turning all night instead of sleeping (and the data will look excellent -- < 1 AHI -- because you weren't actually sleeping, not because your sleep disturbances were being treated effectively!).

I actually really like digging into this stuff, feels like a puzzle to me.

Hope that helps,
Charles

But split nights might not totally be accurate, particularly if there isn't enough time to do an accurate titration. Even when I had a full titration a few years ago, they ran out of time to see if increasing the pressure would do a better job of minimizing the RERAS.

It isn't an issue of medical science catching up with the risk of SSRIs. The information is there but many doctors chose to ignore it. Instead, when someone has an adverse reaction, it is blamed on their "mental illness".

Hydraulix989 wrote:

49er wrote:Hi Hydraulix989,

Welcome to the forum.

Regarding RERAS, making the comparison between what they show after using the machine and a sleep study that shows the figure when it is untreated is not a valid comparison.

Thank you! I agree, and as you know, sleep studies can be performed both, not only without, but also WITH the machine (cf. "split night" studies and titration studies), and so PSG+PAP data can be more fairly and directly compared with the PAP data.

Regardless, CPAP machines don't and CAN'T score RERAs by themselves, by definition; the name is deceptively misused in PAP data. It's definitely not an honest representation of what the PAP machine is measuring at all.

49er wrote:Regarding taking an SSRI, you are aware that many times, they cause insomnia right?

Hm, I never experienced this first hand -- quite the contrary, I have to take my SSRI at night, or I will fall asleep during the day. I realize that this is personal experience, and if you do experience insomnia as a side effect (which DOES appear to be pretty common), then of course, you should disregard my advice. I don't even think medical science has fully caught up with understanding who is likely at risk for the various side effects and contraindications of SSRI use.

Papzombie

Lots of good advice here. What is your diet like? Food feeds the brain. I'm using some supplements, L-tryptophan, GABA and an Amino acid blend and its made a difference.

Good luck

~UB