Managing similarities between OSA and depression?

Seeing that OSA and depression can have similar issues (fatigue,difficulty concentrating,sleep behavior issues,etc) how can one tell if BOTH are being managed efficiently? I was diagnosed with depression/anxiety long before OSA. Honestly, I don't think that my depression/anxiety was 'managed' well, but just 'addressed' and given a prescription off the list of antidepressants. The right med for me? Who knows. But my PCP had me try a few different meds and when I still didn't find one that agreed with me, then she didn't know what to do with me and I'm left in limbo.
(As an aside, no, I do not see a therapist, nor do I wish to, for personal reasons. But I was diagnosed by a professional).

Now that OSA is in the picture, how can I tell which of my lingering issues is related to OSA and which are related to depression? Is it possible to treat them as 2 entities and not one lump issue with similar symptoms?

You certainly should be able to treat them as two separate entities. My first word of advice would be to find a qualified psychiatrist. If you were given several different antidepressant meds, and didn't find the right one, then you need the help of someone more qualified than your pcp to deal with your depression issues. That is exactly what happened to me. I tried several meds that my pcp prescribed. I had one that worked for quite some time. Once it quit working (that can happen), my pcp was out of ideas. He referred me to a psychiatrist, and that has really helped. I still had to go through several different meds, and different doses, to find one that worked, but if you have truly been struggling with depression for a long time, then I would strongly encourage you to seek a referral.

(And my therapist/counselor has been a HUGE help, too. But I won't push that.)

I am being treated for both. I have been using meds for depression since 1987. I did not have OSA at that time. I did also go thru many, many drugs that either didn't work or the side effects were just too much. My family doc does treat both the depression and my OSA. You don't need a mental health professional to deal with the depression just a very good doctor. By the way there are many new anti-depressants, some of which side effects are minimal these days. One just has to be patient while finding the right drug and that is hard since we want to feel better sooner rather than later. It does not sound as if your doc does not have knowledge to treat depression.

Don't let it go because it will only get worse. The meds do work when on the right ones. Everyone wants to feel better and be able to not have the blues so to speak.

Good luck

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Secret Agent Girl:

As a teenager, I had a therapist and a counselor completely alter what I said to them, documented things I never said, all of which resulted in my parents thinking I was suicidal (which I was absolutely not) and sending me for inpatient treatment. It was a disheartening experience--I confided in a "trustworthy" adult that betrayed my trust, then felt betrayed by my parents who trusted the adult vs me and then thrown into an environment (that was just short of terrifying)with kids my age and younger that tried to kill their parents, used drugs habitually,etc. I lost friends that I'd had since elementary school, bc I was taken out of school,wasn't allowed to do much of anything....isolated.

Fast foward to now. My anxiety makes the attempt to seek therapy nearly impossible.Going somewhere new, with someone I don't know, by myself, is very difficult for me, even if I was going for an enjoyable purpose (haircut appts are even stressful). I don't have confidence in therapy as a treatment, and to try it would go against the opinion and thoughts I have on therapy (speaking for myself, not others that seek and benefit from therapy). I have looked for a form of support through email contact, but most will not establish care in that way. And I understand that, but that's the holding pattern I'm in right now.

My pcp and I are going to do a test of weaning me off Celexa this spring. I have been taking it for about 10 years but I think that OSA could be the cause, and not a separate issue.

We are going to work with a local compounding pharmacy so we can reduce the dose very, very gradually.

I'm also not one for therapy. I just can't suspend my skepticism long enough.

SnoozyQ wrote:As a teenager, I had a therapist and a counselor completely alter what I said to them, documented things I never said, all of which resulted in my parents thinking I was suicidal (which I was absolutely not) and sending me for inpatient treatment. It was a disheartening experience--I confided in a "trustworthy" adult that betrayed my trust, then felt betrayed by my parents who trusted the adult vs me and then thrown into an environment (that was just short of terrifying)with kids my age and younger that tried to kill their parents, used drugs habitually,etc. I lost friends that I'd had since elementary school, bc I was taken out of school,wasn't allowed to do much of anything....isolated.
...

Oh man, SnoozyQ! I'm so sorry you had such a terrible experience! No wonder you don't want to see a counselor.

Would you consider seeing a psychiatrist, strictly to manage your medication? I think that might be helpful. I'm not saying your doctor is not knowledgeable about depression or meds used to treat depression, but most pcp/family docs know the basics. One of the reasons I like my pcp so much is that he admits he doesn't know it all, and will make a referral to a specialist when he is at his limit of knowledge. A psychiatrist would know much more in depth about many more meds and appropriate doses to be used for depression, since that's what they deal with. It might also help to have an anti-anxiety med available to take as needed. Just my two cents worth!

SnoozyQ wrote:Seeing that OSA and depression can have similar issues (fatigue,difficulty concentrating,sleep behavior issues,etc) how can one tell if BOTH are being managed efficiently? I was diagnosed with depression/anxiety long before OSA. Honestly, I don't think that my depression/anxiety was 'managed' well, but just 'addressed' and given a prescription off the list of antidepressants. The right med for me? Who knows. But my PCP had me try a few different meds and when I still didn't find one that agreed with me, then she didn't know what to do with me and I'm left in limbo.(As an aside, no, I do not see a therapist, nor do I wish to, for personal reasons. But I was diagnosed by a professional).

Now that OSA is in the picture, how can I tell which of my lingering issues is related to OSA and which are related to depression? Is it possible to treat them as 2 entities and not one lump issue with similar symptoms?

Is it possible that you have had OSA longer than you thought? And maybe the reason why your PCP didn't know what else to try meds wise...is because the OSA was causing it? I think many times we think we have only had OSA for the past couple of years...but it is so slow to develop..it is possible OSA caused breathing problems (and depression problems?) long before we were aware of it. I was in the chiropractor's office the other day and a mother was in the waiting room with her 3 year old son. He had just had his tonsils out...and the receptionist was asking his mom how he handled the surgery. Apparently he had been having night terrors...and breathing problems...so their doctor recommended taking out his tonsils. The beginnings of OSA at 3 years old? Possibly! Just food for thought.

I have yet to encounter anyone that will only manage medications, without regular sessions. That creates a snowball of anxiety for me. So while my PCP does admit she doesn't know what else to do, I have been reluctant to push forward, bc it seems so overwhelming and stressful.

I did have an anxiety medication, but it did terrible things in relation to my sleep (discovered that recently), and I cannot take it anymore.

I was diagnosed with depression and anxiety as a teen, and there were no sleeping/energy issues at the time. I'm sure OSA was an issue for a time before my actual OSA dx, but not back to my teen years. It's possible that OSA and dep/anx have been feeding each other in a negative manner though and perhaps that's why I wonder if my dep/anx was better treated would the OSA treatment be more noticeable. IE: Is insufficient treatment for dep/anx taking me 2 steps back, from 1 step forward with CPAP? Or vice versa? Do I not feel the improvement that my numbers indicate bc of dep/anx or OSA?

SnoozyQ wrote:I have yet to encounter anyone that will only manage medications, without regular sessions. That creates a snowball of anxiety for me. So while my PCP does admit she doesn't know what else to do, I have been reluctant to push forward, bc it seems so overwhelming and stressful.

I did have an anxiety medication, but it did terrible things in relation to my sleep (discovered that recently), and I cannot take it anymore.

I was diagnosed with depression and anxiety as a teen, and there were no sleeping/energy issues at the time. I'm sure OSA was an issue for a time before my actual OSA dx, but not back to my teen years. It's possible that OSA and dep/anx have been feeding each other in a negative manner though and perhaps that's why I wonder if my dep/anx was better treated would the OSA treatment be more noticeable. IE: Is insufficient treatment for dep/anx taking me 2 steps back, from 1 step forward with CPAP? Or vice versa? Do I not feel the improvement that my numbers indicate bc of dep/anx or OSA?

How long how have you been on CPAP? It may take a while for CPAP to help with depression. I am no expert....by any stretch of the imagination. Has anyone found their depression lifted with CPAP therapy?

Since Sept 2010

SnoozyQ wrote:Do I not feel the improvement that my numbers indicate bc of dep/anx or OSA?

and in response to the question, "How long you been on CPAP?" you write:

Since Sept 2010

Snoozy, I'm working from memory---but you and I both joined cpaptalk about the same time. If I recall right, your AHI numbers are good, but you don't really feel any improvement in daytime symptoms? That correct?

Because in that case, then yes, I think that the on-going depression and anxiety issues may well be part (or most) of why you aren't yet feeling better. It could be that without CPAP you'd be feeling a whole lot worse than you currently are.

So---how do you rate the physical quality of your sleep now that you're using CPAP? Has that improved at all? Not the daytime functioning and daytime symptoms---just the sleep itself. Do you think you're sleeping any better in any way you care to define the word better? Waking up less at night, maybe? Or waking up with fewer aches and pains in the morning? Or waking up to go to the bathroom less? Or waking up sweating like it's a 100 degrees in your bedroom less? Or waking up with less evidence of massive tossing and turning every night? Any sense at all (even a very, very subtle one) that the physical quality of your sleep has started to change with the CPAP controlling the number of apneas and hypopneas you have each night? Because if you can honestly answer any of these questions with a yes, then just maybe the CPAP is doing its part in improving your sleep, but the lack of improvement of how you feel really is due at least in part to the other medical issues going on.

I'm fortunate to not be dealing with issues as serious yours. But my own realization that my insomnia monster is what I need to spend my time working on in order to be able to feel the full benefit of xPAP therapy came about (in part) because between the second titration study and the end of December, I did start to notice some subtle but positive changes in the physical qualities of my sleep even though my daytime functioning was still a huge mess---and getting worse. In January the slow steady progress (even with its two steps forward and one step back jaggedness) has left me finally feeling fully function for a few hours each day on most days. I'm not yet back to where I was pre-CPAP; but on days following decent nights, I'm beginning to get close. And so I hope that when (not if, but when) my insomina monster is tamed, I will finally see the benefit of xPAP therapy in my life.

And so I do think that if you are in a holding pattern on the depression and anxiety issues right now, they may well be continuing to suck the life out of you every day---indeed they may be sucking more energy out than the "successful CPAP therapy" is putting into your system on a regular basis. And so the net gain in daytime energy and functioning is, well, zero or even negative. And that means to really feel the genuine positive effect CPAP is having on your body, you will need to work hard on getting the depression and anxiety under control as well. It won't be an easy journey for you. But it will be one that is worth your time and energy since that's the way you will get your life back.

Robysue, overall I would say you are correct: my AHI numbers are fantastic, but I don't feel as good as they indicate I should. I do have great days but mostly they are tired days. A change here and there sparks a short lived improvement. Since turning off the EPR my 7 day data reads that my AHI is 0.7. Last night was 0.2. My nap yesterday was LEAK and AHI FREE and I still slept 3 hours and didn't want to get up. There's no correlation btwn good days and good numbers bc my numbers are always good.

That said, yes, my sleep itself is improved. Aside from a battle with insomnia every now and then, I sleep through the night--no more potty trips,no clock checking 5-6 + times a night.
I worked an entire week last week, which hasn't happened in months. Did I feel great each day? No. Do I feel great now? No. Will I have a great day this week? Maybe.

SnoozyQ wrote: That said, yes, my sleep itself is improved. Aside from a battle with insomnia every now and then, I sleep through the night--no more potty trips,no clock checking 5-6 + times a night.
I worked an entire week last week, which hasn't happened in months. Did I feel great each day? No. Do I feel great now? No. Will I have a great day this week? Maybe.

I think this helps to partially answer your initial question for yourself then:

The CPAP is most likely making you sleep better, and hence giving you (some) additional reserves of daytime energy. But the better sleep in itself and by itself is not enough to address the fatigue you feel each day and the lack of energy and the difficulty focusing because the depression and anxiety are continuing to eat at your daytime energy and ability to function faster than the CPAP can possibly rebuild your badly depleted reserves.

So chances are---those daytime symptoms are now primarily coming from the depression and the anxiety rather than the combination of apnea plus the (depression and anxiety). Maybe it's now time to start working as hard on the controlling the depression and anxiety as you've been working on adjusting to CPAP these past four months. It may be that you will start to feel better only after all three issues---the apnea, the depression, and the anxiety---are all being well managed.

Best of luck with dealing with the depression and anxiety. They are tough beasts that conspire to sap your strength.

SleepyT wrote:Is it possible that you have had OSA longer than you thought? And maybe the reason why your PCP didn't know what else to try meds wise...is because the OSA was causing it? I think many times we think we have only had OSA for the past couple of years...but it is so slow to develop..it is possible OSA caused breathing problems (and depression problems?) long before we were aware of it

Bingo. Depression isn't a disease, its a symptom. (At lot of people get angry at this idea for some reason, its not saying that depression is any less serious) If you are depressed you have to find the cause and threat that. IMHO antidepressants only mask the symptoms. (and sometimes not very well and often with many side effects)