Sleep apnea and Mood Disorders

Sleep apnea is a disorder where you stop breathing repeatedly at night while you try to sleep.  Sleep apnea leads to sleep debt.  Sleep debt has similar consequences to sleep deprivation.

My therapist and docs constantly emphasize the importance of regular, consistent sleep.  Sleep apnea does not allow that.  I find it very interesting that sleep apnea has been found to be very common in persons with mental disorders, including bipolar.  Could it be what pushes some of us over the edge?  Or is it just that we have already sought medical treatment for other reasons and we are thus more likely to discover it in ourselves?  All I know is that after reviewing the below information, I knew I would not leave this unchecked.  I suggest you consider whether you have it.  I anticipate a life-changing result from my CPAP and will gladly update you later.

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This is an excerpt from Awakening to the dangers of obstructive sleep apnea

Psychiatric disorders often are comorbid with OSA. These include depression, anxiety, bipolar disorder, schizophrenia, posttraumatic stress disorder (PTSD), panic disorder, and substance use disorder.

Depression. Several studies have documented that OSA and depressive disorder often are comorbid. Many symptoms are common to both, including fatigue, daytime sleepiness, poor concentration, irritability, and weight gain (Figure), although some core symptoms of depression (eg, sadness, anhedonia, guilt, and agitation) are clearly distinguishable from symptoms of OSA. The current recommendation is that a mood disorder should be considered secondary to OSA, and treated accordingly.5

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Anxiety. OSA also has been linked to anxiety and nocturnal panic attacks. Frequent awakening due to choking from breathing cessation might play a role in the development of anxiety in patients with OSA, although the association is unproven. Studies have shown a correlation between anxiety disorders and excessive daytime sleepiness, one of the core symptoms of OSA. OSA is highly prevalent among combat veterans who have PTSD and complain of being overly vigilant at night; experiencing nightmares and frequent awakening; and having non-restorative sleep. Anecdotal reports suggest an association between OSA and bipolar disorder: namely, that continuous positive airway pressure (CPAP) treatment (see “How is OSA treated?,” below) might switch depressed patients to mania.

Schizophrenia. A strong association exists between OSA and schizophrenia. In a study, OSA diagnosis was made 6 times more often in patients with schizophrenia than in patients with other psychiatric illnesses. Obesity, male sex, and chronic antipsychotic administration were risk factors for OSA in patients with schizophrenia. OSA might be underdiagnosed in patients with schizophrenia because excessive daytime sleepiness, the most common daytime symptom of OSA, can be misattributed as a negative symptom of the disease or a side effect of pharmacotherapy.

Common Side Effects:

  • Loud snoring
  • Abrupt awakenings accompanied by shortness of breath
  • Awakening with a dry mouth or sore throat
  • Morning headache
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Attention problems
  • Irritability

Untreated sleep apnea can lead to:

  • Daytime fatigue and trouble focusing
  • Car crashes and other accidents due to sleepiness
  • High blood pressure, heart rhythm disorders, stroke, and heart attack.
  • Diabetes
  • Liver disease
  • Memory problems
  • Weight gain
  • Metabolic syndrome
  • Sexual dysfunction
  • Depression and other psychological conditions

 

 

Update on my little life

So things have been going okay.  Not perfect, but okay.  We bought a house.  I’ve managed to work pretty regularly.  I haven’t had any major depressive episodes, but I went through a lot of rapid cycling last month.  I was swinging multiple times per day.  To make things worse, my sleep was total shit.  Couldn’t sleep some nights.  Couldn’t get out of bed some mornings.  I was all over the spectrum.  I finally got fed up and went to the doctor.

My general doc told me he didn’t want to put me on any benzos or ambien or lunesta because he was afraid that it would screw with my cyclothymia.  He suggested I see my psych doc.  He did however ask me about sleep apnea.  I already suspected that I had it.  My wife has told me for years that I stop breathing and snore while I sleep.  So the doc prescribed a sleep study.

I went to the neurologist last week and ended up doing the home study a few days ago.  When I went in the get the results I was taken aback.  I didn’t have sleep apnea.  I had seversleep apnea.  I stopped breathing once every 2 minutes  – all night.  I go back next month for a night at the sleep center to get my CPAP settings adjusted.  Then I get my own CPAP and that’s that!

I’m very excited about this because I’ve often struggled with fatigue and irritability, which are symptoms of sleep apnea.  I will discuss these things in another post.

So things are looking pretty good going forward.  I’m trying to remain vigilant, though, because my previous depressive episodes often began when winter started.  I’m all equipped for light therapy with my daylight colored bulbs in my office and my SADS lamp for when I wake up.

Here’s hoping we all have a good holiday!

Surprisingly Stable

I’m amazed at how long it’s been since I had a down or hypomanic episode.  It’s enough to make me feel well.  Yeah right.  These long periods of stability are usually when I stop and look at my habits and try to make some improvements.

I find that when I come out of a depressive episode I don’t necessarily drop the bad habits that come with it.  Eating too much, staying home too much, not working, not exercising.  I’m trying to break these hangover habits at the moment.  I’d like to do that without going overboard.  We’ll see how that works.

I am going to the gym with my wife.  I’m enjoying it thankfully.  I am of course fearful of what will happen when I loathe the idea of being around people again.  I’d prefer to just soldier through it, but that hasn’t happened previously – so it would be a great accomplishment.

I am still tapering off of wellbutrin.  I’m now at a quarter of my original dose.  It has gone very well.  I plan on stopping altogether next week.  My wife and I are both anxious about how that will go.  But it’s for the better.

We are in the process of buying a house.  It has been a roller coaster to say the least.  The bank has gone over our finances with a fine-tooth comb over and over again.  We believe we will close tomorrow thankfully.  I feel that I’ve handled it very well.  Now to make sure I don’t get hypomanic from the excitement of finally getting it.

I’m thankful for these times when I don’t have much to write about.  It’s nice to pretend I’m not sick.  Hope you are having one of those times as well.

Tapering off Wellbutrin

In January I was at my wits end.  I had been depressed for about three months and it was killing my wife who was in turn killing me.  I had hoped that lamitrogine would help with the depressive side of things more than it did.

So I saw my psych and he put me on Wellbutrin aka Bupropion.  He was hesitant because it can trigger hypomania, but he saw how distraught I was and proceeded with caution.

It did jack for a few months, and who knows if it really ever did anything.  A couple months after getting on Wellbutrin, my depression quickly waned after I stopped taking melatonin – a sleep aid manufactured by satan.  Not long after my reemergence I began to question whether I should be taking wellbutrin.  Truth be told, I noticed weird energy and mood spikes while I was on it.  Like nothing I had felt before it.  It was creepy.  It’s as if I could feel the hypomania, whereas before someone had to tell me I was on a high.

I talked to my wife about tapering off of it.  She reacted about like I expected – HELL NO.  Her primary concern, naturally, was that I would slip right back to where I had been for nearly 6 months.  She didn’t have the stamina to deal with that for an entire year.  I didn’t blame her, and dropped the topic.

Last week, we realized that the prospect of getting pregnant was fast approaching.  Her period returned a couple weeks ago.  She is also on wellbutrin for her own reasons.  She has been doing much better and we both hate the idea of her being on the medicine while pregnant.  So I broached the idea of me stopping as well.  I got her to cave.

So now we are two weeks in.  We are both taking half of our prescribed dose each day, dropping from 300mg to 150mg.  A drastic drop if you research the topic, but we may get pregnant fast and decided to expedite things.  We will drop by another half to 75 mg in a week.

Have I noticed symptoms?  A few.  Some mood instability, but mostly energy wise.  Irritability is definitely on the rise.  No depression or anything.  I woke up extremely fatigued today, and it has come and gone once or twice during the day.

We both hope for the road ahead to be smooth.  We recognize the likelihood that it won’t be, but I don’t trust the medicine to help with my overall well-being.  Anything that can unnecessarily trigger hypomania is a danger to me.  We’ll see how it goes.

 

Sleepless nights

I’m sitting in bed as I write this, wide awake.  It’s almost midnight.  Normally I’ve been going to sleep between 9 and 10 for over a year.  But, I don’t always do normal.  I mean, that’s our battle, right?  So sleep has been starting around 2 lately.

So what’s going on?  Hypomania I guess.  I got over an extremely stressful time at work and have been having a lot of sex with my wife.  Life is good!  But I can’t sleep.  I can’t tell for sure, but my wife lying next to me is probably struggling to sleep herself because of me.

If you read a previous post of mine then you know that I’ve tried melatonin in the past which resulted in horrible side effects.  Last night I took Benadryl because I wanted to be fresh for work, but was instead foggy.  I figured I go med free tonight, so this is the result.  Not tired at all.

Strangely to me, I feel better the next day when I go sleepless rather than take some pill.  That’s not so strange if you look at Cyclothymia’s side effects – namely the decreased need for sleep during hypomanic periods.  Not sleepless mind you, but continuing to run strong without a normal night’s sleep.

Supposedly this results in higher stress and worry levels.  I dunno.  All I do know is that I don’t want to take anymore pills.  Screw ambien or benzos or anything else.  I’d rather suffer predictable consequences than chance more new side effects.

Welp, time to go read the news.

 

 

 

Mother’s Day

So I’ve been seeing my mom after a long estrangement.  She suffers from schizo/bipolar type II.  (Explains a lot about me, eh?)  She’s been dealing with it acutely for the past 20 years.  About three years ago I had her committed to the hospital because she had barred her apartment door, nailed it shut, covered all the windows, stopped eating etc.

She was certain that I was out to get her.  She was off her meds big time.  She ended up being in the hospital for six months and went to a group home after.  She wouldn’t talk to me or any other family, and so it went for three years.

Thanksgiving last year I had had enough.  I love my mom and the thought of her floating around alone out there distressed me.  I managed to track her down to an assisted living home.  I slowly began to reintroduce myself to her life.  I’ve seen her once or twice a  month for an hour or two at a time since the holidays.

Despite my initial caution, it is clear that she was and continues to be ecstatic to see me.  I think she definitely felt alone and cut off.  My wife and I took the next big step last week.  We took her out to eat and did a little mother’s day shopping.  She did really well.  Every now and then she’d talk about how she married all four of the Beatles at the same time, and that Paul died and came back to life, but for the most part she was very pleasant and ‘with it’.  She was thrilled to get out of the home and I know is looking forward to more trips.

I always felt as if I abandoned her after her commitment.  She cut me off, but she can’t help it, I’d always say.  I felt responsible for letting things go as I was the one with the greatest ability to reconnect.  Seeing her enjoy herself and feel the love of family gives me a really good feeling.

I was diagnosed with cyclothymia last year.  As you would guess I immediately gained a new appreciation for mom’s plight.  The level of understanding and relation I felt to her was incredible.  I suddenly realized that only I could understand her (in our circle that is).  No one else could truly understand what it feels like to be on an island even when surrounded by your family.  To not be able to control things that you should be able to, feelings, emotions and attitude.

The most important thing I’ve learned about mom, and probably many with mental illness like hers, is to always be positive and never disagree.  Trying to make her realize that Paul never died and that she didn’t marry any of the Beatles would only serve to upset her and view me as a threat.  I haven’t once disagreed with her since our reunion and it is paying dividends.

I always feel like there is a battle for me to fight with this illness of mine.  Thankfully, there are victories here and there such as this.  Mom has family in her life again and clearly does not feel lonely anymore.  When my mom passes on, I will have the comfort of knowing that I reconnected with her and gave us the joy of spending more time together and reconciling.  It’s a great feeling.

 

Plugging the dike

The frustrating thing about cyclothymia is that there is always a new battle to fight.  People who get depressed temporarily merely have to pick themselves up.  People with some anxiety due to work or whatever merely need to adjust their schedule or lifestyle.  I’m talking about regular people who experience these things temporarily, mind you.

But. with Cyclothymia you’re just this dirty old barrel full of holes.  Fix one and find another.  I guess I’m just frustrated.  I got my mood to stabilize.  Now I’m having obsessive anticipatory anxiety, or whatever you want to call.  The planning department.  I read that you have to recognize that the thoughts are anxiety rather than realistic thoughts.  The paradox is that trying not to think about something makes you think about it more because your brain reminds you not to think about it.

So I felt like I did well controlling the obsessive worrying.  And guess what?  Fatigue.  Utter tiredness.  Headache.  Brain tired.  Really frustrating.  I feel like I’m juggling … Things.  I don’t know.  I’m too tired to write anymore.  You get the idea.