OSA and Depression

[conasauga]

2 years ago my aortic valve failed suddenly. I had a biologic replacement valve implanted and 3 days later had a crt, 3 lead pacemaker implanted for slow heartbeat and total left block. The next day I developed Afib and went on Coumadin and more recently Eliquis to de-coagulate. After discharge I developed MRSA in my incision had to delay rehab 3 months while getting the infection under control. Once the infections was resolved I did cardiac rehab. During this time I developed depression and started on antidepressant,
Lexapro 20 mg per diem. I also had several episodes of syncope and two related periods in hospital to try to stabilize BP. I changed cardiologist and terminated diuretics and reduced BP meds and have been healthier heart-wise since. During this period last summer I was referred to a lung doctor for evaluation due to shortness of breath. Sleep study revealed OSA. I was also told I had reduced lung function and asthma. The surgery seems to have caused some neurological damage. I have severe aura without headache(2-3 episodes per day), chronic, but thankfully moderate, vertigo, hearing loss, memory loss, uncharacteristic irritability. I have developed severe nasal congestion. I take flonase, singulair and zyrtec daily. I still have night cough and heavy mucus production while asleep that interferes with Cpap. Cpap machine set at 10. I am going to try an auto cpap machine in hope of better response to my needs. I use a FP simplus mask which seems to be the best for me and I have tried many different ones. Before November 2014 I was healthy. That is my story.

[BlackSpinner]

. I still have night cough and heavy mucus production while asleep that interferes with Cpap.

That is often caused by GERD (silent acid reflux), your esophagus protects itself from the acid by producing mucus which of course makes you cough . Try elevating the head of your bed. Mine stopped the night I started cpap. It comes back if i am very stressed or sleep flat on my bed.

[conasauga]

My PCP thought the mucus was connected to acid reflux. Thank you for explaining why the mucus is not acidic. He prescribed an anti-reflux med. It seems to have helped some but far from complete. I do sleep with my head elevated.

[Julie]

And you might want to consider if your humidifier setting is too high (or even necessary) in relation to local climate, at least e.g. in summer when it's likely more humid where you are - it can certainly cause congestion.

[BlackSpinner]

My PCP thought the mucus was connected to acid reflux. Thank you for explaining why the mucus is not acidic. He prescribed an anti-reflux med. It seems to have helped some but far from complete. I do sleep with my head elevated.

Apneas will cause it for many people.

Another thing to investigate is your meds. Check if any of them have throat irritation or cough as a side effect, if so get them changed. I spent a year and a half dealing with cough and asthma problems which also caused acid reflux because the BP meds triggered throat irritation. Within two weeks of changing the meds the asthma and cough was almost gone.

[conasauga]

I am trying to cut back on humidifier. All appointments but the last one he told me to raise humidification. Yesterday he told me to cut if back. I am kind of frustrated because I think he has lost interest in my case. What do you think of my idea to purchase an auto cpap machine to see if it improved compliancee comfort etc?

[D.H.]

My modest experience is that OSA is enough to exacerbate depression if not cause it. I have so much trouble tolerating the cpap machine that I went several months just not using it. Result was severe sleepiness during day. That is also something to be depressed about. I think anti-depressants are helpful but not curative. I am struggling to be more compliant with Cpap treatment and feel if I can get there that depression will be reduced. As my Doctor told me me, "you have plenty to be depressed about." OSA is only one of the ailments I suddenly find myself dealing with. Having a forum certainly helps. Accepting lower set of possibilities is hard but certainly something many, many people have to face.

Hopefully, you can treat your OSA since that's one less illness whose symptoms will bother you. Also, getting that under control will simplify dealing with additional illnesses.

[BlackSpinner]

I am trying to cut back on humidifier. All appointments but the last one he told me to raise humidification. Yesterday he told me to cut if back. I am kind of frustrated because I think he has lost interest in my case. What do you think of my idea to purchase an auto cpap machine to see if it improved compliancee comfort etc?

Humidification is a very individual thing. We always tell people to experiment. It also can change with the seasons. Play with it to get your perfect level. Julie doesn't like it, my body wants lots.

Secondwind.com has reconditioned machines so try there for an autoset if you want to go that route. For some people it mkes a big difference. Before you do that, find some good movies, put on you machine and mask and spend the time watching while wearing the equipment to get your body/mind used to it. Do that for a week and see if it makes a difference.

Get Sleephead software and check your data to see what it is doing at night.

[Julie]

Do you mean you're only using a plain Cpap (which one)? Autos will also do Cpap, but not the other way around, and it's better to have an auto as you can get a better idea of what settings are best for you... so if your MD won't write a script for one (idiot - insce bill'g codes are the same!) then change MD's! We can help you find the right machine (it matters what you get in terms of data accessibility) with pressure settings and free software to track various parameters overnight to optimize treatment but would need more info re machine, mask (can make a huge diff. to 'compliance' and there's loads out there), etc.

It's not that I don't 'like' humidity, but that I live in a humid area and don't need it.

[conasauga]

Thanks for all the input. I do live in a humid community in Georgia USA. It's very humid in summer but I sleep in an air conditioned house. I am going to try to cut back on humidity in machine and see if that helps. I was originally given, via Medicare, a Resmed cpap. I felt the blower was a little aggressive and do not like the way the reservoir is constructed as it tends to get a bit of water on the furniture next to the bed. My lung Doc refuses to write a prescription to anyone other than the DME he uses. Technically I chose the Dme from A list he gave me as he loves to remind me. I have a good PCP who wrote me an open RX for whatever I wanted in the way of CPAP and supplies. Not knowing any better I bought a FP Icon straight Cpap. I like the Icon better than the Resmed. The reservoir design is better for me. The blower seems a little softer but this is subjective. I have never had rain out with the icon which i did have few times with the resmed. However it is still a fixed cpap machine.As I continue to struggle with compliance I thought about getting a auto cpap. On this blog I saw a RP System One series 60 Auto with bluetooth for $419. I gather that is a well regarded unit although last years technology. Price is a concern but not the only concern. My fixed cpap pressure 11 mm. per sleep study. I think I quoted 10 yesterday but that was a typo. Any thoughts on a suggested auto cpap to acquire.

[Julie]

Go to Secondwindcpap.com and look at what they have available... the machine (60 series) you mentioned is out of date and you'd do better to look at machines named under other posters' notes as you should find a consensus pretty quickly. Go to Cpap.com and look at machines for the variety and reviews and pix, etc. to see which are good... you can find newer ones affordably on SWC once you have a better idea what you're looking for. If you see some you like, post again here and we'll advise if they're good ones (if Cpap.com's write-ups and reviews don't tell you enough). It's vital you get one that gives data and will work with SleepyHead software, and the majority of new ones do. SH also works on Macs btw.

Your MD is obviously getting a kickback from that DME - very bad practice to say the least and he may have an interest in the co. itself... you don't have to put up with that kind of thing - he does not have your best interests at heart!

And just turn off the humidifier for a couple of nights and see how you feel then - it's not therapy, just a facilitator for when you might need it.

[palerider]

Go to Secondwindcpap.com and look at what they have available... the machine (60 series) you mentioned is out of date and you'd do better to look at machines named under other posters' notes as you should find a consensus pretty quickly.

it's only one generation old, and there's little operational change with the newest thing (dreamstation)

[Julie]

Hmmm, well I've seen some of what a certain machine-savvy poster has said in the past about it.

Just trying to present the best possible choices.

[palerider]

Hmmm, well I've seen some of what a certain machine-savvy poster has said in the past about it.

Just trying to present the best possible choices.

oh, there's no doubt that I think that resmeds are superior, but I thought he said he didn't like 'em from a previous test.

I'd suggest PMing grayghost4 and see what he has, also.

operationally, the system one 60 series auto and the dreamstation auto are very similar, if not identical wrt the treatment algorithm.

[Caymangirl]

Yes, crushing depression which improved with CPap. However you should also have your Vitamin D3 checked, because if that is very low it will contribute to the depression. My MD has me take 1000 mg daily, but I am seeing in some new research.that it might not be enough.