Can CPAP cause depression/anxiety?

[davecpap]

I've had a CPAP machine for two weeks now. Past week I've been quite compliant - using it about 7.5 hours a night, good leak numbers, low AHI, etc..

However, while I'm falling asleep less during the day, I mentally feel exhausted. Lots of feelings of depression which are not normal for me, almost daily crying (previously extremely rare - can't remember last time I cried), etc.. feelings of anxiety, which I've experienced years ago but have since been under control with an SSRI. Whats going on? Is this REM rebound? How can I tell? I don't exactly remember dreaming when I wake up.. Both my wife and I thought I was doing better initially last week, more energy in the evenings, etc.. but now BAM - depression?

Very discouraging... Have appt. with sleep doc on Monday, but not sure if he's the best one to be talking to. I've sought the help of a psychologist, but he doesn't seem well versed in sleep. I need a psychiatrist/sleep doctor!

[Wulfman]

I think you're asking the wrong question. The link is between depression and (untreated) sleep apnea.

Hopefully these links still work......I collected them quite some time ago.

Den


Depression & Sleep Apnea:

http://news-service.stanford.edu/news/2 ... ssion.html

http://sleepdisorders.about.com/cs/rela ... iadeap.htm

http://query.nytimes.com/gst/fullpage.h ... sec=health

http://www.annals-general-psychiatry.com/content/4/1/13

http://www.psychosomaticmedicine.org/cg ... 443?ck=nck

http://www.johnshopkinshealthalerts.com ... 388-1.html

http://www.annals-general-psychiatry.com/content/4/1/13


.

[Hawthorne]

I think it is possible for someone to be depressed, initially, when starting cpap therapy.

After all, it is a major life adjustment and this, like most many life adjustments, can often cause some depression. You are not yet getting the full benefit from the therapy.

You say you have dealt with depression in the past. You need to see if this passes as you adjust to using the cpap and sleeping in this manner. If the depression doesn't pass and you are feeling more rested,then you should see someone who deals with depression.

It may be that this depression will lift as you become accustomed to cpap and begin to feel more rested but it is certainly something to keep an watch on.

[BlackSpinner]

Many people get angry when they are diagnosed with what is a major health issue that can not be cured only treated. They go through all the stages of grieve and denial.

Added to that you are making mental adjustments to deal with this - for years your mind has been keeping you alive by waking you up to breathe - now it has to let go of that. You are also dreaming now and going through rem sleep - another change.

Another issues is that when one stress is lifted off another will surface to be dealt with now. It is a real pain but we keep coming back to earlier issues to deal some more with them when ever there is space in our lives. It is like the mind says "No more tigers chasing us? Ok how about we do some garbage collection now"

[davecpap]

Somehow I got to googling, and I was reading that REM suppression alleviates depression... I was trying to figure out if now that I'm on CPAP, the increase in REM is contributing to my depression.

Quite frankly, I wasn's pissed off to be on CPAP - I mean, you're asleep when you use it, so you don't really notice. And I was really, really looking forward to increased energy as I felt my evening naps before bed and sleeping away the weekend were negatively impacting my family life. But now, my sleepiness has been replaced with depression/anxiety

Part of me feels I should stop googling and going to this forum and others and trying to self-diagnose, and just wait until my doctor appointments next week... but then I think of how I'd have a low end, non-data capable cpap machine if it weren't for the info on this forum, so the internet can't be ALL bad. Having data has given me a level of control over my treatment that I find invaluable.

[torontoCPAPguy]

You bet your bunnies CPAP therapy can be associated with depression; either way too (alleviating and causing). Depression is not a simple matter and you are definitely not going to find your answer on a forum. Fact is, that you are very unlikely to find your answer from the first MD you go to. Someone very close to me has been fighting depression for 35 years and there are good spells and bad spells. There are any number of probably causes and any number of probable resolutions. It can be as simple as low B complex in your bloodstream and as complex as multiple personality disorder. And interestingly, it gets even better because it can be any combination of the above and about a thousand other things.

Our problem where we presently are living (Toronto) is that there are few good psychologists and psychiatrists and even fewer that are willing to deal with medications because every single medication interacts with every other medication you are taking. Even taking something as simple as a painkiller can set off depression in folks. Go figure.

The only advice that I can give is to get the best psychiatric and the best physcological assistance that you can possibly find - not the first that you can get your hands on, which is often the case in Toronto and Ontario in general. There are so few really good ones out there. We had a man and wife TEAM that helped us out; he a prominent psychiatrist of the highest order and she a 'non practicing' psychologist of some genius. He as well. They actually became friends as the years went by and we were invited to attend and were present at his funeral. We have never been able to find anyone as good and it has been fifteen years.

What I can tell you is that as far as CPAP therapy is concerned I found, personally, that the first several weeks were unsettling for me. Whereas I was the one in the group that was always stable, logical and calm - I became agitated, easily angered, very emotional, etc. And I can only attribute it to a few things, primarily the return of REM sleep. I found myself sleeping deeper and better but awakening unsettled at times and when I could recall the dreams they were all to do with horrific events in recent times. (In fact my wife is just on the phone with a close family friend of ours and I can hear her telling him about me having nightmares at times now and having more energy during the day with which to contemplate how badly my life has been screwed up over the past three years with illness and so on.) That's the bad news. The good news is that WITHOUT the aid of psychiatric or psychological professionals - just me and my friends and family doctor, the situation has done a 180 and I am now feeling good about things, sleeping better, and so on.

The mind is a fragile and complex thing. There are not hard and fast rules, even for the professionals. All I can tell you is that the chances of having a 180 take place are pretty good if you have a logical head on your shoulders like I do. I simply reasoned out my situation and realize that I am lucky to be alive (the alternative was not great); I am lucky to have had a successful business and while we don't have a great company pension we do have some money in the bank and we do have a very expensive home that will provide for our retirement as we sell it and invest in income property and so on. We are sitting pretty (could be better) but most importantly of all we realize how fortunate we really are, the nightmares and extra energy during the day to think about things has changed so that no more nightmares and when we think about things now we are ok with them. And we have virtually eliminated pain medications that we had been taking for some years for compressed disks in my back. I had been on oxycontin, which is 10 times more addictive than heroin. Gone. On my own.

Get yourself some help. Have someone to speak with that you can confide in. CPAP is good. You will live longer and better. And the depression, the Good Lord willing will be gone. Good luck.

[Janknitz]

I felt exactly the same way when I started CPAP. I was angry with the diagnosis and the idea of sleeping with this chunk of plastic strapped to my face for the rest of my life. I didn't sleep well at first because it took me quite a while to find the right mask and get the proper machine and settings, so I was more sleep deprived than usual.
I found myself feeling very isolated--I couldn't really talk to my friends about CPAP, because the response I got form most people is "just lose some weight and you won't need that anymore [not true!], and NOBODY had the slightest idea what I was going through each and every night. I didn't want to socialize or see anyone. My husband took my daughters out of town for a week during spring break to see his family and I didn't want to go because I wasn't ready to figure out how to travel with the machine yet. So then I was home alone grappling with this and feeling even more isolated.
My anxiety went way up because the masks I was using gave me claustrophobia, and the lack of sleep contributed. I felt the lack of control in my life very keenly, exacerbated by the way my HMO handles OSA (they TELL you what to do and when, they don't ask or engage you in the process--I really didn't like that!).
All I can tell you is that it DOES get better, but you must work at it. You have to work at getting the mask to be comfortable so that you can just put it on and go to sleep. I found that taking control of my therapy helped immensely--when I had access to the data and knew and understood what was going on with the mask and machine, I started to feel back in control of my life again.
Unless you are actively suicidal, I highly recommend that you do NOT start in on antidepressants or sleeping pills for a few more weeks. Give yourself some time to work through it. If you are still feeling lousy in a couple of weeks or worse any time, then do seek help, but you may be fine just giving yourself some more time to adjust.

[BlackSpinner]

Another thing is that once the extra oxygen kicks in many of us need to adjust medications - your body handles them differently. Coffee - I used to drink a lot until 4pm now I can't handle more then 2 mugs and NO coffee after lunch.

Many people need to reduce their blood pressure medications too.

[Janknitz]

Coffee - I used to drink a lot until 4pm now I can't handle more then 2 mugs and NO coffee after lunch.

Interesting. I went many years without drinking caffiene because it bothered me. But when I moved my office into it's present location, which is a sublet, our "landlord" has the best coffee ever. So I started drinking 1 - 1 1/2 cups in the morning. I always had trouble sleeping regardless of whether I had caffiene or not, and that early in the day it wasn't a factor in my insomnia.

Since my CPAP therapy got well-established, I notice I sleep really well. I'm tired at a reasonable time (always a night owl, I used to feel most awake around 10 p.m. and have a hard time going to sleep before 2 a.m.) and I sleep through the night very well, but wake refreshed. I find I can drink more coffee (I still limit it to 2 cups) and later in the day with impugnity. When I'm hooked up and ready to sleep, it seems that now I can sleep no matter what.

I still get sleepy some nights around 9 while watching t.v. I hook up to my machine and sometimes fall asleep for an hour or so. I have no problem going to bed around 11:30 even after a cat nap now. So I seem somewhat impervious to caffiene now.

[Thomas F.]

In my case the lack of quality sleep led to major anxiety and some depression. I had an over reaction to everything . Sad situations affected me 10x worse than a normal person. For example, at a funeral for an friend I cried like a child; it seemed like I had no control over my feelings. Preparing for meeting at work was way more stressful than it should have been. Once I began to get my apnea under control these exaggerated feelings have subsided, but it didn't happen immediately. Is it possible your CPAP therapy is not 100% effective yet and can be improved? I still have days that I don't feel great, but usually I can peg it back to a bad night of sleep. I was never a candidate for anti depression meds or anxiety meds before apnea. Therefore, I feel I don't need meds after properly treating apnea with CPAP because I am my normal self again. My theory anyway.

[torontoCPAPguy]

Do NOT expect a rapid relief from what you have been experiencing for many years! I am six months into it and still in the trenches here. It gets better every week though, that I can assure you if you are persistant. You will find that EVERYTHING gets out of whack though.... and as to medications and interactions and so on. I would have to go along with that because my blood sugar is all over the darned place where before CPAP it was rock steady with a minute amount of Metformin. My pain medications have been reduced (by me) from Oxycontin (!!!) and loads of it (it is 10x more addictive than heroin remember) down to some Tylenol 2's and plain Tylenols as I am better able to deal with my discomforts. It was not easy coming off the Oxycontin let me tell you; they wanted me in a methadone clinic. No way. Gimme a good night of sleep and I can deal with things. Otherwise, I can assure you that I will cry like a baby at ridiculous provocations and over-react to situations to the nth degree.

Seek medical attention for your issues so that you have someone to confide in and treat it. But rest assured that if I am thinking right here, you will be through it all in 6 - 12 months as you recapture sleep and brain cells and get into your 'happy state'. And don't spare the bucks when you need to spend on CPAP gear. It is your LIFE we are speaking about here. I just upgraded from S8 Autoset II's to S9 Auto's and MAN!!! What a difference. Can it be just that they are dead quiet. I don't think so. I think we have a significant leap forward in the algorithms used and in treatment here. My pressures are lower and my everything is lower and better. I cannot believe it and had you told me two weeks ago that this would be the case I would have called you a nutbar. My backup S9 just arrived and I am now going to repack my S8's and sell them. They are still great machines, but just not quite as good as paying double or more for the S9's. The climate control system is about to be tested out as well. I haven't even been using it yet!

Just one thing. What the heck is with the zippers on the BOTTOM of the damn carrying cases? DUH? First time I have ever seen anything like this on any piece of electronics I have ever bought.... or sold (I spent 30 years in the electronics business). It is about as ridiculous as it gets. Zippers at the bottom? What if the zipper fails? The blower is held in with velcro but everything else falls out? D.U.H.? For what they are charging for the gear ResMed should do what Qualcom did when they made a similar mistake and replace ALL of the carry cases with proper ones before there are too many out there and people start losing stuff. Or is it just me?
I wouldn't buy a camera bag with zippers on the bottom; why on Earth would anyone ship a carry case for an equally expensive piece of gear with zippers on the bottom? Someone did a real stupid. Nuff rant. I feel good and Im going back to bed. Zippers ont he bottom ... I'm going to dream about this tonight I am sure. It's like putting zippers on the back of men's pants.

[Rustyolddude]

Before you go any further with therapy or medication, get your testosterone level checked. It's a quick & easy blood test which should be done before going further. Blood should be drawn in the morning as this is the when you T level is at it's peak. A web search will give you the levels for your age group. Low T as it's called is often overlooked and a common cause of depression in men, along with fatigue, inability to focus, and a generally poor sense of well being. Doctors are too quick to prescribe meds to treat depression when there is another underlying cause.

[M.D.Hosehead]

Dave,

I'm afraid you are going to have to live with ambiguity and unanswered questions, no matter how many professionals you see.

This is because no one knows the cause of depression; there is no single cause. Obviously, there are no end of studies showing correlations between depression and X. But correlation is not evidence of causation (e.g. there is a correlation between ice cream sales and incidence of death from drowning, but neither one causes the other). Consider how complicated your question is.

There is a genetic contribution to mood and anxiety disorders. If you have it, the disorders tend to wax and wane or to remit and recur, often for no discernible reason. Most people with depressive tendencies adapt to their individual pattern, and learn ways to push through the dips. Most people with anxiety disorders likewise learn ways to adapt. A new wrinkle, such as adjusting to being on xPAP can change the way those learned adaptations work, but it's a safe bet that people who have learned to adapt in the past, can learn to adapt again.

Medications, notably antihypertensives, birth control drugs (I noticed you gender is M; I'm speaking in general here), steroids, opiate, sedative and alcohol use and abuse, ineffective choice of antidepressant, too high of too low dose of antidepressant, are just the beginning of the list of possible pharmacological factors.

Concurrent medical conditions, like autoimmune disorders, viral infection, hepatitis , mono, thyroid imbalance (hypo or hyper), anemia, post-partum, post-op, perimenopause, plus whatever CNS changes result from treatment of sleep apnea could all interact in a case like yours.

Marital or relationship problems, job stress, financial stress, moving, personal loss, whether real or threatened, are a few examples of psychological factors that can trigger depression. Even taking online material too seriously or without a dose of skepticism can effect one's mood.

I need a psychiatrist/sleep doctor!

I can almost answer your need. I am a psychiatrist and I have sleep apnea. I've also been involved in sleep research. I'm no expert in sleep apnea, but on the subject of depression, I'm in "speaking" in my area of expertise.

Part of me feels I should stop googling and going to this forum

That would be a mistake IMO. I've not found any other single resource as helpful to me. However a skeptical view of individual posts is important. Keep this in mind: depression almost always gets better. Never give up.

[Mary Z.]

The process of adjusting to having a chronic disease goes through stages until you get to acceptance. Depression is one of those stages. You may feel as though you've accepted the diagnosis and machine, when actually deep down you're struggling with the concept. You go through the same stages with heart disease, diabetes, anything that's chronic, life threatening and requires constant attention. Give youself a break, you may need a mild sedative or antidepressent to get through this stage, but you must work through it. OSA can seem so innoucous unless you're having really bad symptoms, you may consciously have not come to terms with the diagnosis, yet. Perhaps you can find a therapist who is used to people with sleep disorders, perhaps your sleep doc can recommend one, or help you himslef. Sometimes you have to ask around or call around to the therapists avaiable to you and see if they have someone on staff familiar with sleep issues.
Good luck, hang in there, take care of yourself, and keep us posted.
Mary Z.

[davecpap]

Thank you everyone for these kind words. I would have never been able to get this far if it wasn't for the folks on this forum, since I don't know anyone else going through this.

I had my follow up with the sleep doc today. He was VERY surprised to find out that I wasn't doing cartwheels yet after 2 weeks on CPAP. I told him that I'd read online that it can take weeks or months to start feeling better, and he said that wasn't his experience. He wanted to start me on provigil, which I'm very anxious about. I've made an appointment with another sleep doc to get a second opinion.

My current sleep doc wrote me a script for an auto-titrating machine based on two previous sleep studies in 2008 and 2002 by other physicians. I enquired about a 'fresh' sleep study to see if my sleep structure was still fragmented, if I have PLMS, etc... but he didn't want to do a sleep study since my AHIs on the data card are under 5 and my compliance looks good (7hrs/night average).