Anyone trying to treat OSA with comorbid mental illness

G'day,

This is a long shot but I just wanted to know if there is anyone else on the board that is attempting to treat Obstructive sleep apnea via CPAP that suffers from a mental illness? If so, did the new sleeping patterns exacerbate your mental illness?

-Matt

Please define mental illness.
Many suffer from anxiety disorders, making acclimation to treatment more difficult.
We can partially understand how PTSD would affect treatment--and vice-versa.
Some other problems, it would seem, may more likely improve due to enhanced brain oxygenation.
Still others are understood best by those afflicted, more so than by their doctors, but I hope not.

Matty332 wrote:G'day,

This is a long shot but I just wanted to know if there is anyone else on the board that is attempting to treat Obstructive sleep apnea via CPAP that suffers from a mental illness? If so, did the new sleeping patterns exacerbate your mental illness?

-Matt

I assume you're asking if (1) there are people here who have mental illness, in addition to OSA, and (2) did using CPAP exacerbate their mental illness. Is that correct?

In response:
(1) Yes, there are so many people who come through here, that lots of people meet criteria for some mental disorder or another.
(2) I don't know that I've ever seen anyone post anything to suggest that CPAP made them worse, and many have said it's improved their anxiety or depression, which makes some sense. I can't imagine why CPAP would make a mental illness worse, except perhaps indirectly if adjusting to CPAP leads to increased sleep deprivation during the adjustment period. I don't know that I've seen enough people with PTSD post about how it is for them to adjust to CPAP.

Please post which mental illness you're referring to.

Matty332,

I suffer from depression and have been on CPAP for almost 3 months. I have been told that good sleep will help me in my fight with the depression. My trouble right now is just trying to get the CPAP titrated right so that I can hopefully decrease the amount of medication I take for the depression. Don't give up! Keep in touch with us on the forum.
Know His Peace,
Wildman 2
BOB

I suffer from chronic depression. Used to be called chronic dysthymia, punctuated by mild to moderate depression. Whatever you call it, sometimes a trap door opens and my mood drops; it takes time to recover. . .

I've been on PAPpy for 6 months, and I believe that it is helping my mood somewhat. I still have bouts of insomnia, but I do feel more alert in the morning than I used to.

Don't know if that is what you are asking, but that's my story & I'm sticking to it.

I thought it might aggravate my Post Traumatic Stress Disorder but it has actually worked well. I always used to fall asleep clutching something beside the bed (usually the nightstand leg), but now the pap grounds me instead. Much of my PTSD is related to oral rape as a child, and I think that having my mouth covered by the full face mask also helps me to sleep better through the night (plus, no more chewed up pillows, sheets and pj's).

It'd help to know what you were considered about. In most cases I see CPAP treatment helping mental illnesses. Feeling crappy due to sleep apnea doesn't help dealing with any mental illness.

The only one I could see it doing weird things with would be bipolar disorder as abrupt changes in sleep can lead to manic/depressive episodes. However any danger of such should subside once therapy has gone on for a few weeks.

In fact, after writing the above I checked on PubMed and there is an incident of CPAP therapy (and subsequent changes in sleep) preceding a manic episode (so my "hunch" wasn't too far off).
http://www.ncbi.nlm.nih.gov/pubmed/18794515

Still such is a very, very rare occurrence and shouldn't make anyone with bipolar disorder not go on CPAP therapy (just continue to take mood stabilizers/be appropriately monitored while starting therapy/let all doctors know what is going on) as in the long run proper sleep should help someone with bipolar disorder (its just that adjusting to that has the *theoretical* potential to be a little rough). In fact many people with Bipolar disorder report CPAP therapy as a huge help (http://www.apneasupport.org/about15885.html). However, it's the only mental disorder I could come up with that could theoretically interact negatively (temporaily) with CPAP therapy.

http://chestjournal.chestpubs.org/conte ... l.pdf+html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2045710/

http://130.237.98.166/content/1/c6/03/0 ... aranti.pdf

Personally, I suffer from mild PTSD (as a paramedic, I had a rather traumatic call about 15 years ago; no regular meds) and seasonal depression (dx 5 years ago). I didn't start on meds last fall, but I felt great; no depression noted. I also started started CPAP in November 2011. I don't know if the CPAP has kept me from feeling depressed/needing meds.

I also suffer from very long-term insomnia (started as a teen - I'm almost 43) and now have taken Ambien for 8 years.

Several years ago a board member wrote about being on meds for being bipolar, then after starting cpap it got really bad. She believed her symptoms were really sleep deprivation all along, or maybe once she was sleeping her needs changed. Her meds were reduced and at some point she went off them. Not sure if that's the kind of thing your're wondering about or not.

While we would generally expect long term mental improvement from CPAP, it wouldn't surprise me if the stress of adapting could make it worse for a while. For that matter, if your mind and body have adjusted to the effects of apnea, your mental problems might get worse when things change. Chemical and hormone balance might change.

Maybe being exhausted all the time would keep some people from engaging in certain self destructive or manic behaviors. Exhaustion is sort of like sedation in some sense.

Your meds might need to be adjusted, too.

Like I said, I'd expect things to get better most of the time with CPAP.

I believe that allowing a person to start breathing well and allowing a person to start sleeping well are going to improve everything that has the potential to improve. Certainly, deciding not to breathe well and not to sleep well can only make things worse in the long run and is not going to improve anything lastingly.

I have heard sleep docs who are also shrinks say anecdotally that EVERY patient of theirs with mental difficulties and OSA improves mentally with effective treatment of the OSA. One respected (by me anyway) psychiatrist/sleep doc said something like this to a room full of apnea patients in Manhattan: "We used to teach that mental-health problems cause bad sleep. Now we know that bad sleep causes mental problems." An oversimplification? Maybe. Most pithy statements are, one way or another, aren't they? But it is food for rational thought nonetheless.

Not sure if my experience helps, but prior to OSA, I was what you would call a social butterfly. I had to have human communication and interaction I'd find a reason to call about switching my cable package or something like that just because lol. Since OSA, I've noticed a gradual decrease in my want to be around people. I won't even call to order pizza! I've been on cpap for a couple of weeks so I'm not expecting to see a change yet, but I can say I still don't feel like the real me yet.

Hubby says I've been running on a shorter fuse since starting cpap but the snaps here and there are better than being snappy all day long. For example, prior to cpap, if my kids were tossing around a stuffed animal in the house, I would just take it away and tell them they know better. The other day they were tossing the same stuffed animal around the house, and I was already cranky from something else so snapped bad, I grabbed it, scolded them and then I uh, ripped off one of the arms and tossed it in the trash... Granted it was a cheap fair stuffed toy, but still... Prior to OSA I would have been a lot more calm about it and did the good mom routine where I explain why somethings wrong in a fairly normal tone.

esangston wrote:Hubby says I've been running on a shorter fuse since starting cpap but the snaps here and there are better than being snappy all day long. For example, prior to cpap, if my kids were tossing around a stuffed animal in the house, I would just take it away and tell them they know better. The other day they were tossing the same stuffed animal around the house, and I was already cranky from something else so snapped bad, I grabbed it, scolded them and then I uh, ripped off one of the arms and tossed it in the trash... Granted it was a cheap fair stuffed toy, but still... Prior to OSA I would have been a lot more calm about it and did the good mom routine where I explain why somethings wrong in a fairly normal tone.

Prior to having untreated OSA or prior to beginning CPAP you would have been calmer? You seem to be saying both. Lots of people have a shorter fuse when they are tired. Have you started decreasing your Dexedrine or are you on the same amount as before?

archangle wrote:. . . Exhaustion is sort of like sedation in some sense. . . .

I think that is well said. OSA can dull our senses to the point that we begin to lose connections with our life and lose our ability to feel much, good or bad. Treatment of that condition can allow us to reconnect to our life and to begin to see, hear, and feel things again--but if we don't like what we see, hear, and feel, and we begin to sense the pain or the irritations that we were too tired to perceive before, the ride can get bumpy. The solution is to find constructive ways to deal with the pain and irritation while finding ways to notice the joys of life, not to disconnect again by choosing exhaustion/sleepiness over problem-solving. Choosing not to clean the windshield of our car because we don't like the way the road looks may bring a false sense of comfort to us temporarily, but that is never a wise choice for collision-avoidance. In my opinion.