Depression & Sleep Apnea

Symptoms of Depression in Individuals With Obstructive Sleep Apnea May Be Amenable to Treatment With Continuous Positive Airway Pressure

Chest. 2005;128:1304-1309

Objective: To assess the reversibility of symptoms of depression using continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA).

Patients/methods: Patients referred to our center for evaluation of OSA who had a respiratory disturbance index (RDI) 15 and who demonstrated a significant response to CPAP ( 50% drop in RDI) were evaluated for the symptoms of depression using the Beck Depression Inventory (BDI), and then reassessed after 4 to 6 weeks of treatment with CPAP at home.

Results: In this group of patients, the institution of CPAP therapy resulted in a significant (p < 0.0001) decrease in those symptoms of depression as assessed by the BDI (BDI at baseline, 4.1 ± 3.7; BDI after CPAP, 1.0 ± 2.0). This change in BDI was noted both in those individuals who had received an antidepressant prescription prior to referral, and in those who had not. An analysis of variance failed to reveal any effect on these data related to gender or baseline RDI.

Conclusions: Patients with OSA may present to their primary care physician with symptoms suggesting a diagnosis of depression. In some of these individuals, the symptoms of depression may be ameliorated with CPAP.

Introduction
We noted that a substantive number of the individuals referred to our center for evaluation of obstructive sleep apnea (OSA) had been prescribed antidepressant medication prior to referral. In a preliminary review of 114 consecutive cases referred to our center, 45 patients (39%) were receiving antidepressant medication at the time of referral. When evaluated with the Beck Depression Inventory (BDI) [BDI-Fast Screen for Medical Patients; The Psychological Corporation; San Antonio, TX],1 we found that 41% of these patients had a score suggesting at least mild symptoms of depression, and 12% had a score suggesting moderate-to-severe symptoms of depression.

My emphasis.

PUblished in 2005 - It takes time for knowledge to spread.
Maybe sometime in the future, a home based sleep diagnosis will be the first step in diagnosing people who comlain of fatigue and depression. And hopefully soon more psychiatrists and psychologist will be taught about sleep apnea as part of their training.

O.

Well, Saturday night I went for my follow up sleep study for titration. I woke up feeling pretty much the same as always, but the longer I was awake yesterday, the more I noticed that I felt less tired and crappy than usual, even though I ended up falling asleep on the couch around 7 pm and was in and out until I finally just went to bed at around midnight. Is this normal after a study?

Anyway, the sleep study experience was just as weird as the first time, I didn't feel like I really slept at all, because I was so aware of the mask and the wires the entire time. But I guess I did get some sleep because I didn't feel as horrible as usual yesterday...

But today I feel even worse than usual. Not just tired, it's impossible to concentrate and I feel really anxious, and it was so hard to drag myself out of bed this morning and go to work. This is the worse it's ever been. I'm scared. What's wrong with me?

Saturday night, when the technician was hooking me up to all the wires, I asked her how long after the study it would take for me to get my own machine, and told her that ever since the first study I've been more aware of how tired I am and it just makes everything so much worse. She said it would take 2 weeks (again) to get the results of the study back, and after that she wasn't sure, but it shouldn't take more than 6 weeks. Six more weeks of feeling like I just want to roll over and die? Nope, I just absolutely cannot do that.
I'm already on intermittant medical leave from work, so I'm working decreased hours. And when I get home, I have no energy to do anything except crash on the couch and watch TV. I can't do this anymore. I feel totally worthless and I just want my life back. I hate myself when I'm not productive.

Last week, I emailed my sleep doc asking if I could get an AutoPAP machine until the results of the second study came back, and I got my own permanent machine. I have yet to hear back from him.

So my question is: What do I do/say to convince him that I need an AutoPAP machine, or something NOW! and that I cannot just wait around for the study results and whatever else? I'm really shy and not very assertive, and I never seem to say the right things to get what I want/need. Help! I feel like my life is falling apart.

Hey there!

From what I have read here at this forum, the complete frustration and hopelessness of the time between diagnosis and treatment starting is well-documented. I know I felt it, and I was one of the lucky ones... I got my machine in THREE DAYS. For me, those three days were like swimming in sticky syrup... I just could. not. imagine. spending. another. minute. like. that. That said, there are people on this board who had to wait three months!!!

My sole recommendation is the "bug the heck out them" method, which I used with great success. Call and ask to be scheduled in if there is a cancellation. Ask if you can move your followup a week earlier. Ask if there is a better way to get a message to the doctor besides email. On one of my calls, I asked for the nurse to give me a call back with some recommendations on how to improve my sleep BEFORE CPAP... I just said, "you know, I am very anxious to start my treatment as soon as possible but my appointment is not for X weeks... can you tell me what I can do in the meantime? What is helpful, what is harmful?" She told me a few things, and moved my appointment one week sooner. Each time I called they were able to find a slot for me a little sooner until I ended up having my follow-up and gear pickup the Friday after my titration study on Tuesday. I wasn't rude, just politely asked questions and expressed how earnestly I wanted to get started with this.

Quite honestly, I think the delay is ridiculous. First they tell you how serious it is, you are killing yourself, this is very dangerous, you must have treatment, here's all the bad side effects... now come back in six weeks and we'll get started! To me that is like being diagnosed with a broken leg and being told come back in 6 weeks for a cast.

Anyway, I know some times it is tough being assertive - I am shy myself. But I wanted this really really badly, so I made it a point to call, politely, and ask them to do what they could to get my treatment started right away.

Let us know how it turns out.

Dawn

Yeah, what Dawn said! Call, call back and call again....and again....and again. Politely (key word here...."POLITELY"...) remind them how bad THEY have said untreated OSA is and what it's doing to your body. I know that I probably decreased the time between my sleep test and getting my machine by 2 or 3 weeks. AND I found out they "lost" my study, at least until I made the calls to the right folks...about the 3rd time, it "turned up". LOL

Keep the faith! It WILL get better.

Kajun

amandalee,

I can feel your pain. Everything you are saying about your physical and emotional state sounds like me before I started treatment. Your emotions are reacting to a bad physical condition.

Dawn is correct that you should try to accelerate the schedule. Call the doc's office and find out who is in control of the schedule. Tell them your situation and ask for help. Have them put you on a wait list for canceled appointments. Be nicely persistent through the whole process.

In the meantime try to sleep only on your sides. For most people, apneas are much more frequent and longer when sleeping on the back. There are some tricks to force yourself to sleep on your side. If you have problems sleeping on your side just ask for tips here.

Life can be good for you soon, but you just have to try to hang in until you can get the cpap therapy.

Rooster

Thanks for the suggestions.
Since my Dr's office is probably closed now, I decided to send him one more email, and if I haven't heard from him by tomorrow afternoon I'll call his office and bug him some more. This is what I sent, along with forwarding my previous request for an AutoPAP machine. Let me know what you guys think:

Dr. H----,

I had my second study on Saturday night. While I was there I asked one of the technicians how long it usually takes following the study to get my own machine and start treatment. She said it would take 2 weeks to get the study results back, and that she wasn't sure on the machine, but it shouldn't take more than 6 weeks.
I understand that it takes time for test results to be analyzed, etc, but I really don't feel like I can wait any longer for treatment. I'm already on intermittent medical leave from work, and ever since the first study, I've been much more aware of how tired I am, and how much of a struggle it is to concentrate and get anything done. Despite working reduced hours and doing everything I can to try and get enough rest, it is literally all I can do to drag myself out of bed, go to work, and attempt to be productive. I'm worried that I'm going to get fired if this goes on for much longer.
Once I get home from work, I have no energy to do anything besides crash on the couch and watch TV. This is the worst the fatigue has ever been, and I feel like my life is falling apart.
Besides that, I'm aware that untreated OSA can have other serious medical consequences like high blood pressure, coronary artery disease, and an increased risk of traffic and work related accidents. Continuing to go without treatment for a condition that can have such serious complications really worries me. For other serious medical problems, such as diabetes, I doubt there's such a delay between diagnosis and starting treatment.
Lastly, I've already wasted years going to different doctors with the primary complaint of "being tired all the time." After being told to "just try and get more sleep," or "it's psychiatric, take this antidepressant" (5 different ones, to date); you were the only doctor who actually listened and took me seriously. I really hope you can help me start treatment as soon as possible. While I'm waiting for treatment, is there anything else I can do to improve the quality of my sleep?
It's just so frustrating to finally know what's wrong with me, and know there's a treatment for it, but have to wait, especially when I feel so miserable. I hope to hear back from you soon.

Thanks,
Amanda

It's too bad I can only express myself that well in writing, rather than in speaking.

Amanda, that was a nice, polite letter that laid out things pretty well. Only suggestion is that you didn't really tell the Dr. exactly what you wanted him to DO and when! Hopefully he'll call you back and then you can let him know exactly what you want/need and when.

Best of luck!

Kajun

I agree with the keep bugging principal. You said you would wait until tomorrow afternoon, I would call first thing in the morning. Make sure that they are VERY aware of how bad you feel--so aware that they start to feel bad too. It is good to be polite--keep being polite. Be the most polite pest you can possibly be. You aren't going to feel better until you get on the hose and there are many steps to go thru to get the machine, so pester them! That is what I did and I got mine probably a week earlier than I would have otherwise. I started calling the sleep lab EVERY DAY at least once, asking, "where do things stand now?" Have they looked at my data? Has the report been sent to my doc, has my doc sent the scrip, then on to the dme, calling them: you will get my scrip x day, can I make an appt now for my fitting? What are the major brands you carry?

Be prepared. Have an idea what type of machine you want to buy. Most of us would recommend an auto. Research masks now, basing your research on how you felt about the kinds you used during your titration. Keep reading here. The more you are prepared and are aware that the first 2-3 weeks aren't going to be easy, the smoother your transition to full compliance will be.

I don't know you, I don't know what kind of person you are, but right now you are going to have to be your own advocate and use all your extra energy to focus on this and getting this accomplished. Bring on your inner bitch, you may need it! If you have a strong family member or friend who can go with you to any of the meetings or fittings, just having another pair of ears to listen and another voice to say what you need and waiting isn't an option--do it!

I know how you feel. I was where you are at the beginning of June. Keep plugging and you will make it to the finish line. You are so young, you will more than likely be surprised by how fast you bounce back. it has been 6 weeks for me on the hose, 4 of them fully compliant and I feel like a million bucks and have for a couple of weeks.

Don't despair--WE are all pulling for you!

Jen

I am glad you sent the email. On the other hand, I never had much luck getting doctors to do something. In my experience the "underlings" in the office know how to get things done. I suggest you call tomorrow morning and try to find an underling who will "take up your case" and get it moved along quickly.

In an earlier post you said, "Six more weeks of feeling like I just want to roll over and die? Nope, I just absolutely cannot do that." Let a key underling know you are this desperate. Keep it simple on the phone - you don't have to express it as well as you did in the email if you can get to the right person.

Good luck.

rooster wrote:I never had much luck getting doctors to do something. In my experience the "underlings" in the office know how to get things done. I

I love your email, I think it says just what you want it to, but I agree... I never spoke with the doctor before my appointment, but I think I was persistent enough with the others in the office that she had heard tell of me long before I arrived for my appointment.

I think you should call in the morning and ask if there is anything you can do to get your appointment moved up, and tell whomever you are talking to how serious you believe your condition is, and you will do whatever they need you to do to move this along. As it turns out, my appointment was one day later even that it "had" to be because my insurance had to pre-certify that they would pay for the equipment and she was waiting on that. Once I found out that was holding up the show, you'd better believe I was on the phone with the insurance and burning up the fax lines until every thing was settled. Just find out if there is anything at all you can do.

Dawn

These replies are all very helpful, thanks so much.
I just remembered that tomorrow is a state holiday here in Utah--Pioneer Day. Those of us who work for national companies (me) still have to go to work, but nearly everyone else gets the day off. I'll call anyway though, at the very least I can annoy the answering service...

Here's the thing: I'm not sure whether I should call the sleep lab or my Dr's office. He has a separate practice and is only at the sleep lab on Wednesdays. My initial appointment (and only one, so far) with him was at the sleep lab. Maybe I'll just call both places...

I was referred to the sleep lab in the first place by the employee health clinic here at my work. While they are great for helping with minor things like prescribing allergy medication and whatnot, I don't trust them to actually contact me with test results from specialists they referred me to (like the sleep lab, for instance...) so I've just been contacting the lab/Dr. myself to try and find out test results, set up the follow up study, etc. Good thing too, because I haven't heard a word from the clinic yet about my results.

So aside from the help & advice I get from you kind folks, I am doing this on my own. I don't have a doctor on my side to help me pester the sleep lab/Dr. into treating me.
The sleep lab never mentioned anything about setting up an appointment with the Dr. to go over my results. Should I try to set one up?

Dealing with the "health care" system is such a nightmare...

PS-- Jen, your little boy is so cute!

I went for a follow up with a sleep doc and it was a complete joke. I found out later the sleep clinic i went to isn't accredited. That said, I still think my study was valuable, but I'm damn glad i got an auto.

The most important thing right now to focus on is getting your equipment. I would call the sleep clinic and ask all your questions and then ask if you should call the doc. Emphasize your feelings of desperation. The fact that you can't work is pretty important. They should be made very aware that you are completely debilitated. If you feel like crying, it couldn't hurt. But maintain politeness. People will do amazing things to help people when they are nice.

Now, if they turn out to be rude and uncaring, that is when you break out the bitch-fest.

Don't hesitate to call. I always apoligized for being a pest each time i called, but I kept calling, every day. And emphasizing how exhausted I was. I evoked sympathetic responses and I am certain the tech put a rush on my stuff (a rush that still took 2 weeks, buy hey--that is better than 3!). They really seemed to care (the one tech in particular that I kept calling back bc she seemed to care) and I think they helped push it thru.

Get names when you call--so if someone seemed helpful you can ask for the same person. That makes it personal and makes them feel important and like you trust them, like them, think they are capable.

Let us know how it goes!

Jen

Well, I have an appointment on Tuesday to go get my machine! Hooray! I'm looking forward to leaving the ranks of the walking dead and rejoining the living. And not a moment too soon... Yesterday I was so tired that I had to call in sick to work. I ended up sleeping all day. This is not good.
Anyway, it turns out my sleep doc emailed me back yesterday afternoon saying he had read my study and left a prescription with the lab. I just got off the phone with the lab, and the guy I talked to said he'd be showing me how to set up the equipment and that I would leave with my machine and stuff that day!
So I'm wondering, will they just give me some random machine, or how does this work?

_________________

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

It might be some random machine to take home the first day, BUT you are usually on a rental for the first while, so you have OPTIONS!

This is what I did. I didn't even do it entirely on purpose, but it was EFFECTIVE.

I took in a ream of paper that was printouts of products from https://www.cpap.com

They knew I had done my research. They knew that I KNEW I could buy online (that is a veiled threat, really, I never said a thing). I kept rifling thru them when they asked me what kind of mask i wanted to try etc. They also knew that I KNEW how much these things cost.

I had printed out the price/feature comparison charts for my style of machine and it was on top.

I made it VERY CLEAR that I NEEDED a machine with data capability. I didn't push for the auto because while I wanted one, I wasn't certain that was what I needed and more than anything I wanted the DATA.

Apparantly i am the first customer to ever care. They sent me home with a "dummy" but ordered me an auto bipap (my scrip is bipap, yours may vary). I got the new machine 2 weeks later. They set it at my scrip (16/12) and I promptly went home and changed it to auto mode and tweaked my settings after seeing data. I now run a very tight range 10 to 16 which gives me relief from hi pressure most of the night, but can quickly take care of any events should they arise. The autos and other straight cpaps with data are about the same price wholesale, so they got the auto. They don't know that I changed the settings and i like it fine that way for now.

Every dme will be diff. However, it can't hurt to let them know you are informed and willing to take your insurance dollars elsewhere if they don't give you the service you want and deserve. You may have to bring out your inner bitch, but good sleep is worth it. I took my last prozac yesterday (been 10 mg every other day for two weeks--down from 40 mg) and have suffered no discontinuation symptoms so far. Mood is stable. I'm happy and productive aside from the minor worry of upcoming tonsilectomy on Monday.

Good luck. See if you can get them to move up the appt. Express your desperation. It might work.

Jen

I only read the first post in this thread, so I apologize if I'm being redundant.

I have been diagnosed with some form of depression since I was 5 years old. Don't you love over-analytical mothers? I love my mommy, I really do, but I'm really glad I'm GROWN UP NOW and not dependent on her anymore.

I'm currently taking Lexapro, an anti-anxiety med. I've been on it for about 4 years. I've taken most of the other SSI's and some other meds, on and off, for years. I even had a stint on Lithium. That doctor was a wack job, and I quit that. I am NOT bipolar.

ANYWAY... I have notice this since my "breakthrough" which occured for me about week 7 (that would be around June 8, 2007) - I am taking things easier. Okay, my knee jerk vocalizations/typing are still there (last night's rant on the Pur-Sleep was classic Barb knee jerk crap, again, I apologize), but I'm recovering from that faster, not BROODING on stuff so much, and not going home after a tough day at the office and planning my suicide. That is NOT an exagerration - I have a very detailed plan on how to commit suicide without causing any undue trauma and mess...

I'm currently having my period, so I'm not feeling 100% great this week. I'm having some painful stuff at the office - budget meetings, can you relate? - and I've got a family thing that's sorta bugging me. I'm blue about it. I'm mulling it over repeatedly. BUT, I'm not feeling completely maudlin and suicidal. I can re-focus my mind off it much easier than before.

I've questioned my coworkers, and they all think I'm MUCH NICER LATELY. I'm FAMOUS for my BAD ATTITUDE that brings the whole office down. Trust me. Wanna read my personnel file? I'm the fat middle aged bitch that everyone you've ever known avoids at work, and complains about over dinner. I AM THAT WOMAN.

I'm LESS of that woman these days. And I'm beginning to see light at the end of the tunnel.

My life isn't exactly FIXED, but I can now see areas of improvement, and I have the mental and physical energy to start making changes that I just couldn't before. You should see my office. It's all clean and pretty and everyone in the building keeps coming in here to ooh and aah over it...

I have heard from several sources that people have been diagnosed as psychotic pre-cpap, and NORMAL once they got their sleep apnea under control. The explanation for that has probably already been stated before I got here - but it involves the all night pumping of adrenaline into your body by the apneas.

GOOD LUCK! HANG IN THERE, AND FEEL FREE TO VENT HERE!

Hugs,
B.