Do SSRIs influence sleep architecture significantly?

I am on an SSRI, as well as a high dose of the benzo klonopin. I also drink a lot of caffeine. I know for a fact that caffeine, being a stimulant, suppresses slow wave sleep. Benzos of all types also suppress slow wave sleep and I have been told that by a sleep doctor who is a psychiatrist as well. But the SSRI...I feel it times has become overstimulating on CPAP and makes me mildly agitated since CPAP. If I increase my pressure even a small amount, the SSRI becomes much more powerful feeling and after a few days, intolerable and I have to reduce my pressure.

This is a catch 22 for me.

I was on the SSRI long before I was put on CPAP. But I have wondered if all these psych meds of SSRI plus klonopin is keeping my CPAP from letting me get down into really deep, restorative sleep? Or is that a pipedream?

I am very good about taking these medications, take them every single day never miss a beat. Very reliable, very consistent on the medications. Same thing for my hypertension medication.

Eric

EricinNC wrote:But the SSRI...I feel it times has become overstimulating on CPAP and makes me mildly agitated since CPAP. If I increase my pressure even a small amount, the SSRI becomes much more powerful feeling and after a few days, intolerable and I have to reduce my pressure.

I can't remember what SSRI you are on, so I don't know if it's one of the more activating ones or not (and I probably wouldn't know anyway...I know Prozac is activating.)

I was on the SSRI long before I was put on CPAP. But I have wondered if all these psych meds of SSRI plus klonopin is keeping my CPAP from letting me get down into really deep, restorative sleep? Or is that a pipedream?

No, it's possible that your various medications are interfering with your sleep. You may also be playing a tug of war between the sedating ones and the stimulating ones (e.g., caffeine). And you should not be using caffeine late in the day if you are having agitation.

I am very good about taking these medications, take them every single day never miss a beat. Very reliable, very consistent on the medications. Same thing for my hypertension medication.

Yes, you're very good about taking them, but you sometimes take more than the prescribed amount of Klonopin. That could make you sedated during the day, which might make you feel you need more caffeine, etc.

Much as you hate doctors, you need to work with your doctor on your particular case. Your disorders have symptoms and the medications have side effects. He might be able to sort out which are which.

SleepingUgly wrote:

EricinNC wrote:But the SSRI...I feel it times has become overstimulating on CPAP and makes me mildly agitated since CPAP. If I increase my pressure even a small amount, the SSRI becomes much more powerful feeling and after a few days, intolerable and I have to reduce my pressure.

I can't remember what SSRI you are on, so I don't know if it's one of the more activating ones or not (and I probably wouldn't know anyway...I know Prozac is activating.)

I was on the SSRI long before I was put on CPAP. But I have wondered if all these psych meds of SSRI plus klonopin is keeping my CPAP from letting me get down into really deep, restorative sleep? Or is that a pipedream?

No, it's possible that your various medications are interfering with your sleep. You may also be playing a tug of war between the sedating ones and the stimulating ones (e.g., caffeine). And you should not be using caffeine late in the day if you are having agitation.

I am very good about taking these medications, take them every single day never miss a beat. Very reliable, very consistent on the medications. Same thing for my hypertension medication.

Yes, you're very good about taking them, but you sometimes take more than the prescribed amount of Klonopin. That could make you sedated during the day, which might make you feel you need more caffeine, etc.

Much as you hate doctors, you need to work with your doctor on your particular case. Your disorders have symptoms and the medications have side effects. He might be able to sort out which are which.

Ive only been taking extra klonopin for the past three months. Previous to that my CPAP was working fine and things were fine and I was very consistent on my dosage of klonopin...same about every night. That changed after I began changing machines recently and they were not cutting it and a lot of old symptoms came back in spades. So I resorted to taking extra K to just knock myself out cold.

My psychiatrist acts apathetic about sleep medicine generally and does not want to seem to relate the two...he gives me the strong impression they are completely separate and changing one should not change the other.

Eric

Try to find a board certified sleep doc who is a psychiatrist. And don't even think about launching into an attack about psychiatrists. Or doctors. Or Obama. You would benefit from a sleep doc who is a psychiatrist. Don't argue with me.

SleepingUgly wrote:Try to find a board certified sleep doc who is a psychiatrist. And don't even think about launching into an attack about psychiatrists. Or doctors. Or Obama. You would benefit from a sleep doc who is a psychiatrist. Don't argue with me.

I already tried that and he did not want to touch my psych meds. the only thing he wanted to do was get me off caffeine as much as possible, but he is like that with all his sleep patients. The other stuff, he was not "going there." He was afraid.

Eric

I'm so sorry that you're having such difficulties.

The second sleep doctor is being malpractice careful in not wanting to mess with the med prescriptions of your psych doctor. He is assuming that the levels you are currently on are necessary to control your condition and so is hesitant to change that since he is not your primary psych doc.

So, you can try a couple of things.

1) Absolutely get rid of caffeine in your diet. I discovered that it really messes up my apneas if I have any at all after about noon. Even a 6 oz Coke after noon or so and my stats go completely bonkers. <sigh> I do love real Coke.

2) If the new sleep doc is associated with a sleep center, ask if a new sleep study is appropriate now that your meds have changed and you're having difficulties with the new machine. It may be that the new machine is no longer appropriate for what's happening with the new med levels and a study is needed to identify what changes can be helpful.

3) If you have a data capable machine and the software, print reports from before the meds changed and after they were changed and show them to both docs. Keep a careful diary of what you observe and have that available too.

4) If neither will budge or offer any suggestions for a solution, perhaps it is time to seek a second opinion from docs at a major medical center such as Mayo Clinic, The Cleveland Clinic, Duke University, or some other similar one nearer to you. My personal experience is at the Mayo Clinic in Rochester Minnesota. For complex cases you get sent around to several specialties who TALK to each other and really try to get everything sorted out.



Hang in there, it can be made better.

I can empathize with you and am sorry to hear that you are having such problems.

My PDoc looked up SNRI (not SSRI) and found that it could affect REM architecture. We moved all my psych medicines to the morning to reduce the amount in my bloodstream during sleep hours as much as possible.

JDS74 wrote:I'm so sorry that you're having such difficulties.

The second sleep doctor is being malpractice careful in not wanting to mess with the med prescriptions of your psych doctor. He is assuming that the levels you are currently on are necessary to control your condition and so is hesitant to change that since he is not your primary psych doc.

So, you can try a couple of things.

1) Absolutely get rid of caffeine in your diet. I discovered that it really messes up my apneas if I have any at all after about noon. Even a 6 oz Coke after noon or so and my stats go completely bonkers. <sigh> I do love real Coke.

2) If the new sleep doc is associated with a sleep center, ask if a new sleep study is appropriate now that your meds have changed and you're having difficulties with the new machine. It may be that the new machine is no longer appropriate for what's happening with the new med levels and a study is needed to identify what changes can be helpful.

3) If you have a data capable machine and the software, print reports from before the meds changed and after they were changed and show them to both docs. Keep a careful diary of what you observe and have that available too.

4) If neither will budge or offer any suggestions for a solution, perhaps it is time to seek a second opinion from docs at a major medical center such as Mayo Clinic, The Cleveland Clinic, Duke University, or some other similar one nearer to you. My personal experience is at the Mayo Clinic in Rochester Minnesota. For complex cases you get sent around to several specialties who TALK to each other and really try to get everything sorted out.



Hang in there, it can be made better.

None of my doctors talk to each other. None of them act like they even care.

Eric

Ive got a printout from sleepreviewmag.com and it says the following: SSRIs have nominal effect on slow wave or deep stage restorative sleep. SNRIs such as Effexor can hae some negative effects on SWS sleep. Some of the miscellaneous antidepressants such as Remeron and Serzone actually increase slow wave sleep and do not affect sleep architecture.

On the other hand, all the benzos such as klonopin are marked as markedly decreasing slow wave sleep, severely.

On top of this I have several psychopharmacology books by psychopharmacology expert Dr. Stephen Stahl, MD and he says the same thing. I actually know more about psychopharmacology than anyone here, I just wanted to ask to see who thinks they are up on this. LOL

Im just "afraid" to try going off my SSRI, even though at times the CPAP seems to make it overstimulating feeling.

Eric

EricinNC wrote: I actually know more about psychopharmacology than anyone here, I just wanted to ask to see who thinks they are up on this. LOL

I bet you know more about delusions of grandeur than anyone here, too.

Im just "afraid" to try going off my SSRI, even though at times the CPAP seems to make it overstimulating feeling.

Do NOT go off your SSRI except under medical supervision. You have enough problems without adding that to the mix.

Given that you were just trying to "see who thinks they are up on this" rather than to get some actual help, I'm out. Good luck.

SleepingUgly wrote:

EricinNC wrote: I actually know more about psychopharmacology than anyone here, I just wanted to ask to see who thinks they are up on this. LOL

I bet you know more about delusions of grandeur than anyone here, too.

Im just "afraid" to try going off my SSRI, even though at times the CPAP seems to make it overstimulating feeling.

Do NOT go off your SSRI except under medical supervision. You have enough problems without adding that to the mix.

Given that you were just trying to "see who thinks they are up on this" rather than to get some actual help, I'm out. Good luck.

If you are not a psychopharmacologist, its highly unlikely you know more about psychopharmacology than I do. Being a chronic mental patient for many years prior to CPAP (and CPAP made me a not chronic mental patient for several years btw), I learned more than a thing or two.

It is just that I am wondering what is keeping my sleep from feeling "deep and restorative" feeling. My gut hunch believes its a combination of klonopin, SSRI and too low CPAP pressures, but I am just unsure about it. I know for a fact when I reduce my klonopin, my sleep feels much deeper for a week or so and then becomes the usual sleep. Better on CPAP than off, but still nothing great.

Eric

It seems to me you have answered your own question. You might want to switch to an atypical antidepressant like Remeron which has a positive effect on deep sleep and is one of the most potent antidepressants. However, it has a really big and important side effect: it makes you want to eat carbs like they are going out of style.

SSRI's are known to decrease deep restorative sleep.

Another alternative that you have is to go off the drugs under a doctor's care and try to feed yourself better. You see, neurotransmitters are made by our bodies from amino acids. While some people will have you believe that there is no way that a modern person is going to be deficient in amino acids, my own research shows otherwise. There are various digestive problems that can cause malabsorption of proteins or lack of complete breakdown of proteins into their component amino acids. The prevalence of food allergies points to the fact that large proteins are being absorbed by the body, leaving the immune system to deal with them--a scenario that technically is not supposed to happen. I don't know why some of us don't break down protein well, but the fact remains that it is true.

There are many amino acid supplements touted as having antidepressant properties. Like 5-HTP being the precursor for serotonin (normally made from the body from tryptophan). Melatonin is also made from serotonin and then converted back to serotonin in the morning when you are exposed to light. For those with sleep issues, this is a nice 2-fer. If you are too mellow and need activation, the amino acids tyrosine and DLPA are sometimes recommended. Perhaps the most reasonable and simplist thing to do is to eat more high quality protein throughout the day and (20 g 3x a day is one recommedation I have read and 3 eggs has about that and is one of the highest quality and easiest proteins to digest) AND with the protein take a high quality digestive enzyme, to make sure you are getting the most out of it. That will help your body do what it is supposed to do and you don't need to worry about other parts of the body being starved of the protein it needs. Like hair, nails and internal organs. Those are kinda important.

Personally i start my day with eggs because i have mild blood sugar issues. I take a digestive enzyme by Jigsaw that focuses on protein with every protein meal as well as betaine hcl. Antidepressants no longer help me and they were actually affecting me negatively as well (sleep). If the neurotransmitters are NOT THERE, taking an antidepressant to keep them there makes no sense and cant do much.

God, the universe or evolution did not make antidepressants. Big man-made companies did. They altered one small part of the chemical structure of a compound known to be in the brain so that it could be patented. It won't work as well as the real thing, but it sure makes money. Look up the chemical structure of the drug Lyrica, for example, and you will see it is the same as the structure of the amino acid/neurotransmitter GABA except for one small part. Powerful stuff, this.

Might make sense to move away from your study of psychopharmacology and into the realm of nutrition. You might start with a book like, What Your Doctor May Not Tell You About Antidepressants. There are many more out there like it too.

Jen

socknitster wrote:It seems to me you have answered your own question. You might want to switch to an atypical antidepressant like Remeron which has a positive effect on deep sleep and is one of the most potent antidepressants. However, it has a really big and important side effect: it makes you want to eat carbs like they are going out of style.

SSRI's are known to decrease deep restorative sleep.

Another alternative that you have is to go off the drugs under a doctor's care and try to feed yourself better. You see, neurotransmitters are made by our bodies from amino acids. While some people will have you believe that there is no way that a modern person is going to be deficient in amino acids, my own research shows otherwise. There are various digestive problems that can cause malabsorption of proteins or lack of complete breakdown of proteins into their component amino acids. The prevalence of food allergies points to the fact that large proteins are being absorbed by the body, leaving the immune system to deal with them--a scenario that technically is not supposed to happen. I don't know why some of us don't break down protein well, but the fact remains that it is true.

There are many amino acid supplements touted as having antidepressant properties. Like 5-HTP being the precursor for serotonin (normally made from the body from tryptophan). Melatonin is also made from serotonin and then converted back to serotonin in the morning when you are exposed to light. For those with sleep issues, this is a nice 2-fer. If you are too mellow and need activation, the amino acids tyrosine and DLPA are sometimes recommended. Perhaps the most reasonable and simplist thing to do is to eat more high quality protein throughout the day and (20 g 3x a day is one recommedation I have read and 3 eggs has about that and is one of the highest quality and easiest proteins to digest) AND with the protein take a high quality digestive enzyme, to make sure you are getting the most out of it. That will help your body do what it is supposed to do and you don't need to worry about other parts of the body being starved of the protein it needs. Like hair, nails and internal organs. Those are kinda important.

Personally i start my day with eggs because i have mild blood sugar issues. I take a digestive enzyme by Jigsaw that focuses on protein with every protein meal as well as betaine hcl. Antidepressants no longer help me and they were actually affecting me negatively as well (sleep). If the neurotransmitters are NOT THERE, taking an antidepressant to keep them there makes no sense and cant do much.

God, the universe or evolution did not make antidepressants. Big man-made companies did. They altered one small part of the chemical structure of a compound known to be in the brain so that it could be patented. It won't work as well as the real thing, but it sure makes money. Look up the chemical structure of the drug Lyrica, for example, and you will see it is the same as the structure of the amino acid/neurotransmitter GABA except for one small part. Powerful stuff, this.

Might make sense to move away from your study of psychopharmacology and into the realm of nutrition. You might start with a book like, What Your Doctor May Not Tell You About Antidepressants. There are many more out there like it too.

Jen

Id really like to get off antidepressants entirely, to be honest. I have been on Remeron before and it does improve sleep, but it makes you fat as a pig. I have said many times before if it was not for the making you fat as a pig side effect, Id just stay on Remeron all the time.

However, the other part of it is if my pressure is increased to the median or 95th percentile, the antidepressant feels like somebody set a firecracker off underneath me. And becomes intolerable.

Eric

And I hope it goes without saying. You MUST discuss all this with your doctors and make any changes under their supervision. BTW--benzodiazapens like Klonipin are absolutely terrible for sleep. That would be the first one i would try to get rid of, if it were me.

socknitster wrote:And I hope it goes without saying. You MUST discuss all this with your doctors and make any changes under their supervision. BTW--benzodiazapens like Klonipin are absolutely terrible for sleep. That would be the first one i would try to get rid of, if it were me.

Yeah I am aware of that. I just cant get off the stuff. My blood pressure goes up like crazy when I go off klonopin or attempt it. Benzo withdrawal is the worst. When I have been successful at it, my sleep is deeper feeling.

Eric