How Much Is SA, How Much Is Depression?

This section is for spouses of Apnea Patients to provide mutual support.


How Much Is SA, How Much Is Depression?

Postby ShelJT » Thu Jan 26, 2012 7:58 pm

My husband was diagnosed with sleep apnea about a month and a half ago and his doctor put him on an oxygen concentrator. I basically forced him to tell his doctor about his horrible snoring and the fact that he stopped breathing when he slept. It's been a huge blow to his already damaged ego and he doesn't want me to see him with the tubes up his nose.

First of all, the concentrator is NOT working. He's breathing through his mouth, snoring as loud as ever and I think he's still stopping breathing when he's asleep. (The sound of the machine sort of soothes me to sleep, so I'm not waking up all night to check his breathing like I used to.)

Second of all, my husband also has PTSD, anxiety, and depression. And he is on medication for that, as well as in counseling. Over the past two years, he's gotten grouchy and grumpy and more argumentative than usual.

Here is my question: He falls asleep whenever he's not playing on the computer, watching tv, or interacting with me and the kids. My mom used to have sleep apnea and she would fall asleep while she was talking to us! Nothing could keep her awake. My husband seems to be able to stay awake when he wants to and I'm wondering if he's just shutting down because he's bored and depressed. He claims it's because of the sleep apnea but we've had problems with him hiding in the computer when he was depressed for many years.

Am I crazy? Am I a big ol meany for not buying the "I either have to play on the computer or nap because of my sleep apnea?" Also, he won't tell our doctor that the concentrator isn't working like it's supposed to and that he needs the CPAP machine because of his manly pride. I just want my sweet TonyBear back, and if it takes a machine to make that happen, I'm all for it!
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Re: How Much Is SA, How Much Is Depression?

Postby robysue » Fri Jan 27, 2012 4:08 am

ShelJT wrote:My husband was diagnosed with sleep apnea about a month and a half ago and his doctor put him on an oxygen concentrator. I basically forced him to tell his doctor about his horrible snoring and the fact that he stopped breathing when he slept. It's been a huge blow to his already damaged ego and he doesn't want me to see him with the tubes up his nose.

First of all, the concentrator is NOT working. He's breathing through his mouth, snoring as loud as ever and I think he's still stopping breathing when he's asleep. (The sound of the machine sort of soothes me to sleep, so I'm not waking up all night to check his breathing like I used to.)
Oxygen by itself will NOT help sleep apnea. Is hubby on a CPAP? If not, why not?

The problem with just supplemental O2 and apnea is that if your airway is collapsed and you're not breathing, the O2 just ain't gonna get through the blocked airway.

And with a CPAP, the airway is propped open by slightly pressurized room air. And unless there's another underlying medical condition that warrants being on O2, the CPAP by itself should be enough to take care of the apnea AND keep hubby's nighttime O2 levels up where they are supposed to be.

Am I crazy? Am I a big ol meany for not buying the "I either have to play on the computer or nap because of my sleep apnea?" Also, he won't tell our doctor that the concentrator isn't working like it's supposed to and that he needs the CPAP machine because of his manly pride. I just want my sweet TonyBear back, and if it takes a machine to make that happen, I'm all for it!
My opinion? You're NOT a "big ol meany" for not buying into hubby's excuses. Rather you are doing him a major favor by not being willing to enable his denial of his conditions.

You say that he is under treatment for the PTSD, anxiety, and depression. And that he's both on medication and in counseling. Any chance hubby has been willing to put you on the HIPPA lists for any of his doctors? If so, that gives you the right to discuss his condition with the docs. And if you are on the HIPPA list, I'd say that it's time for you to report to the doc(s) treating the PTSD, anxiety, and depression that hubby has gotten worse in the last two years instead of getting better (so maybe his meds need to be looked at---a lot of the psychiatric drugs used to treat anxiety and depression can cause mood changes as a side effect. And the mood changes may or may not be noticeable to the person taking the drugs. And mood changes (for the worse) while on these drugs are potential side effects that should be reported to the doc who prescribed them. And while you're at it, report the fact the supplemental O2 has done nothing to improve hubby's sleep to the sleep doc. If you're not on that HIPPA list, make sure you go with hubby to his next appointment with the sleep doc. Inform hubby that as the spouse, you're the one who knows what's going on during the night when hubby is sleeping and that you need to tell the sleep doc what you've witnessed.

As for hubby's "manly pride" and his refusal to consider using a CPAP---maybe this approach might work: Does hubby know that a large number of NFL players have OSA and that many of them DO USE a CPAP? Google "NFL players with OSA" and you'll get some hits that you can show hubby about NFL players who use CPAPs. Maybe that will allow hubby to retune his notion of "manly pride" to include treating this serious health condition with a therapy that actually works for it rather than the ineffective oxygen therapy that he somehow doesn't regard as undermining his "manly pride" even as his health continues to deteriorate because he is not taking proper care of himself.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Re: How Much Is SA, How Much Is Depression?

Postby ShelJT » Fri Jan 27, 2012 5:03 pm

robysue wrote:Oxygen by itself will NOT help sleep apnea. Is hubby on a CPAP? If not, why not?


He was diagnosed after they had him use a monitor on his finger overnight here at home. His blood oxygen level dropped dramatically. I don't know why the doctor put him on this concentrator instead of a CPAP, but she hasn't offered him a CPAP and he won't make an appt with her to tell her that he's still having episodes. He says that the concentrator makes him feel like less of a man and the CPAP machine would be too much for him to handle.



robysue wrote:If you're not on that HIPPA list, make sure you go with hubby to his next appointment with the sleep doc. Inform hubby that as the spouse, you're the one who knows what's going on during the night when hubby is sleeping and that you need to tell the sleep doc what you've witnessed.


I go with him to his appointments but he won't make the appointment with the doctor to let her know the machine isn't working well. He says that the concentrator makes him feel like less than a man and the CPAP machine, which his mother uses, is more than he can handle.

robysue wrote:As for hubby's "manly pride" and his refusal to consider using a CPAP---maybe this approach might work: Does hubby know that a large number of NFL players have OSA and that many of them DO USE a CPAP? Google "NFL players with OSA" and you'll get some hits that you can show hubby about NFL players who use CPAPs. Maybe that will allow hubby to retune his notion of "manly pride" to include treating this serious health condition with a therapy that actually works for it rather than the ineffective oxygen therapy that he somehow doesn't regard as undermining his "manly pride" even as his health continues to deteriorate because he is not taking proper care of himself.


He's not a sports fan of any kind, he's far from a macho kind of guy. He USED to be a big ol teddy bear. When I met him, he was trying to get his elementary education degree so he could teach little kids. Chuck Norris, he isn't. I think it's the fact that his mother has to use a CPAP machine AND he knows my mom cured herself by losing 100 pounds so he thinks he just needs to suck it up and lose weight. Well, if it were that easy, we would both be skinny by now!


I would like to know if it is normal with sleep apnea to just fall asleep unless being mentally stimulated. :-(
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Re: How Much Is SA, How Much Is Depression?

Postby robysue » Sat Jan 28, 2012 1:06 am

ShelJT wrote:He's not a sports fan of any kind, he's far from a macho kind of guy. He USED to be a big ol teddy bear. When I met him, he was trying to get his elementary education degree so he could teach little kids. Chuck Norris, he isn't. I think it's the fact that his mother has to use a CPAP machine AND he knows my mom cured herself by losing 100 pounds so he thinks he just needs to suck it up and lose weight. Well, if it were that easy, we would both be skinny by now!
First thing---congrats to your mom. She's one lucky woman and I sincerely hope she keeps the weight off and that the apnea doesn't redevelop.

But hubby needs to understand that treating his OSA is NOT an issue of just "sucking it up and losing the weight."

You see, both you and your hubby need to understand that for most folks with OSA, losing the weight does not cure the apnea: For most of us the problem is in our physical anatomy---in other words, it's how our upper airway is put together and not our weight. For example, I'm a 5'1" female who weighs 107lbs and I have moderate OSA. Most certainly I can't cure my apnea by losing weight. And for many overweight folks with OSA, the question of whether the weight caused the apnea or whether the untreated apnea lead to the weight gain is not an easy question: It is known that untreated OSA can lead to metabolic changes that make it easier to put excess weight on and make it harder to take it off. And so there is growing evidence for a large number of overweight OSA sufferers that it's the untreated OSA that leads to the weight gain, which then worsens the apnea, which leads to more weight gain, which worsens the apnea, ..... A truly vicious cycle that for most folks only ends once they start treating the OSA with a CPAP.

So hubby needs to not compare himself to your mom. And since his mom is on CPAP and OSA tends to run in families, you should keep telling him (over and over and over) that his OSA problem is NOT his weight, but rather it's the anatomy of his upper airway. HIs upper airway is simply too small. Or his soft palate is too long. Or his uvula is too long and large. Or his tongue is too large for his mouth or perhaps his tongue is simply attached too far back. Or his smooth muscles in the throat relax too much when he is asleep and allow the airway to collapse---and it's important to understand that these smooth muscles are not like biceps or hamstrings---there's no way to exercise them and make them less likely to relax during sleep. And that regardless of which of these potential anatomy issues are the most significant problems in his case, the fact remains that he's not responsible for the structural problems in his upper airway's innate anatomy.

My point is that since he's feeling "less of a man" because of this diagnosis and therapy, he is probably blaming himself for developing OSA. And he needs to understand that he may very well had OSA back when he "skinny" and that even if he did manage to lose a significant amount of weight, he might still have the OSA because it could just be caused by the way his upper airway is put together. In other words, hubby needs to quit beating himself up about having OSA and needing a CPAP.

One thing that might help hubby come to grips with his diagnosis is finding out that there are a significant number of OSA patients (including those on CPAPs) who are of normal weight or even down right skinny. Some estimates say that as many as 40% of all OSA patients are NOT overweight. And understanding that fact may help him realize that he did not cause the OSA by simply gaining too much weight. And once he quits blaming himself for the disease, he may become more willing to accept therapy.

I find it odd that he's more willing to do the O2 therapy than the CPAP just because his mom is on a CPAP. Supplemental O2 is serious stuff---at least that's how it seems to me when I'm visiting my mother-in-law who does not have apnea (as confirmed on a sleep study) but does have COPD and has had to use O2 at night for years. Her O2 set up is significantly harder to travel with than my BiPAP is. And, of course, with the O2 you have to extra careful with any potential source for sparks or flames, neither of which is an issue with PAP therapy.

Many CPAPers are not able to articulate just how unsexy they perceive themselves to be---particularly when they know they have to mask up after the fun and intimacy of making love is over. It helps to have a spouse who is willing to tell you directly to your face when you are masked up that the spouse still finds you attractive and sexy and that the spouse is still happy that y'all got married all those years ago. I know: I've had to tell my hubby more than once that I need to hear him sweet talk to me when we're curled up at bedtime and I've got my mask on. I really do need to hear him say that he's still crazy about me when I have the mask on each and every night night. And when he tells me these things on his own, it makes me feel that the machine really is not such a huge issue as I tend to believe it is.

So you will need to remind him on a daily basis that you still find him desirable (and sexy!) even when you see him with the cannula in his nose. I'd strongly recommend that you waltz right into that bedroom when you know he's masked up and give him a great big kiss his cheek or forehead and tell him that to you, he's the sexiest man around and that it means so much to you that he's willing to do this night after night in order to treat his apnea. (And continue doing this if/when he's finally switched to a PAP macine.) Yes, he's embarrassed to be seen in the mask---in part because he's worried that you will recoil and think that he's only a shell of a man if you see him with all that medical stuff on his face.. So you need to convince him that you are not appalled by the sight of him in his mask and that with or without the mask, you find him desirable. In other words, you will need to give him some plenty of meaningful reminders of your love for him even though he wears a mask at night and how much you appreciate the fact that he masking up every single night in order to stay as healthy possible for you and the kids.

And of course, what could possibly be more manly than putting your wife and kids first and doing what you know is the right thing to do for your health by masking up each and every night even though you don't want to. A real man, after all, wants to be around and be healthy for his family for many, many years to come. And untreated OSA rather dramatically increases the risks for all kinds of nasty things that are far harder to live with than a CPAP machine. Things like strokes, serious heart disease, type II diabetes, drug-resistant hypertension, and even depression. Not to mention problems caused by the excessive daytime sleepiness, including a much elevated risk of causing a car crash because of momentarily falling asleep at the wheel.

I would like to know if it is normal with sleep apnea to just fall asleep unless being mentally stimulated. :-(
Excessive daytime sleepiness is one of the most commonly reported symptoms of untreated or under treated OSA. Many successful CPAPers look back on their pre-CPAP days and describe them as "sleeping through life." Many successful CPAPers remember a time (pre-CPAP) when they were literally terrified about falling asleep while driving. Many remember a time prior to their diagnosis when they could fall asleep at a the drop of a hat, anywhere and anytime, but never waking up from all these daytime naps feeling any more rested. And yes, with enough mental stimulation (and caffeine), these folks would manage to not fall asleep---for at least a while.

Other successful CPAPers remember the exhaustion of untreated OSA as making it a chore to get through any kind of activity that they were not particularly interested in---and worrying about falling asleep at inappropriate times such as in class or in meetings at the job. But many of these same CPAPers can also remember that staying up at night doing something that was interesting and mentally stimulating to them was not all that difficult. You see, some untreated OSA sufferers develop a kind of unconscious resistance to going to bed each night because the unconscious mind realizes in way that the conscious mind does not that going to bed and going to sleep is going to start cycle of repeated mini-suffocations that make sleep so unrelaxing and non-restorative. And some folks with untreated OSA can develop insomnia even while falling asleep in micro naps (and real naps) throughout the daytime.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Machine: PR System One BiPAP Auto
Mask: Swift FX for Her
Humidifier: System One Heated Humidif
Year Diagnosed: 2010

Re: How Much Is SA, How Much Is Depression?

Postby ShelJT » Sat Jan 28, 2012 6:35 pm

Thanks so much for all the advice. I think you hit the nail on the head about feeling "unsexy." I'm going to point out that being able to breathe at night, getting a more restful sleep, would make it easier for us to be in the mood and to be intimate! Also, he has suffered from nightmares and we chalked it all up to his PTSD from childhood trauma but your point about the mini-suffocations really rang true. At the very least, not being able to breathe in his sleep is contributing to his fatigue and depression.

I feel sure that losing weight will work for him, though. We've been together for about 15 years now and he hasn't always had sleep apnea. He's always snored, but he didn't stop breathing. He gained weight, the snoring got worse and he started having trouble with waking up choking. It went away when he lost the weight last time. I feel certain that losing weight will improve his condition. However, I like the part you wrote about it taking a real man to use a CPAP mask, even when he doesn't want to, for me and the kids and to make sure that he stays as healthy as possible for us.

I'm also going to emphasize the point that the sound of the concentrator (which is a rolling machine thingy...not an oxygen tank, just to clarify) working actually HELPS me sleep. I find the rhythmic whoosh rather soothing. And I doubt the CPAP machine is going to be any different. It does nothing to detract from my love for or attraction to him to see him wearing the tubes. All I want is the loving, less grumpy, more well-rested and alert man that I fell in love and had babies with. And treatment for his sleep apnea...at LEAST until he loses the weight he needs to lose...might just help get him back for me.

Thanks again :)
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Re: How Much Is SA, How Much Is Depression?

Postby amethyz » Tue Jan 31, 2012 12:39 am

Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.

This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.

(In this case people that has sleep disorder will surely lose weight) I don't think i want to have this kind of illness.
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Re: How Much Is SA, How Much Is Depression?

Postby onewaypockets » Mon Feb 06, 2012 5:08 am

Very often men with symptoms of grumpiness, feeling tired, panic attacks, nightmares, unsureness, etc, have low testosterone. Testosterone is very much a calming hormone. You also might want to make sure his magnesium intake is enough. 600mg of Magnesium Citrate daily is calming as well.

I would push him to wear a CPAP mask....tell him it's temporary while you both start an exercise program together. Since he is down on himself, you might have to be the one to literately drag him out the door and participate with him.

Let us know how he's doing!
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Re: How Much Is SA, How Much Is Depression?

Postby Dianne » Mon Feb 20, 2012 3:32 pm

Time to tape record his breathing and play it back for him AND possibly his doctor. I didn't hear you mention referral to a sleep doctor or sleep lab. You need to get to a sleep doc and sleep lab for a diagnosis. It sounds like apnea, but a sleep doctor and lab will give you a better idea of what is happening when he sleeps.

Yes, depression can come from apnea/poor sleep quality. Best wishes, you sound like a wonderful wife.
Dianne's: Remstar Auto M, C-flex, smart card. Mask: Swift LT. AHI- 23, lowest blood ox 80%.

John's: Resmed S8 Autoset II w/EPR, Mask: Respironics Profile-lite
severe apnea, Cpap user for more than 20 years.
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Re: How Much Is SA, How Much Is Depression?

Postby FrancesA » Thu Jun 07, 2012 9:45 pm

RE: How much is sleep apnea and how much is depression?
It is impossible to tell, because sleep apnea can cause depression.

RE: Weight loss and sleep apnea:
A lot of people do improve if they lose weight, BUT, sleep apnea makes it impossible to lose weight. It makes you low on oxygen at night. You need oxygen for your brain to function optimally and for your body to make necessary repairs when you are asleep. If your O2 is low at night, your body goes into sympathetic nervous system overdrive (panic or fight-or-flight mode) because it is being suffocated. That excess of sypathetic nervous system activity raises blood coritsol and blood glucose and blood pressure, causes insulin resistance which leads to diabetes. It is pretty much impossible to lose weight when one is low on oxygen at night because of the damage low nocturnal oxygen does to one's insulin regulatory system.

Also, being low on oxygen at night impairs a person's cognitive ability during the day. So don't take no for an answer from you husband--his frontal lobe is not functioning correctly while his sleep apnea is untreated.

And without a release, your husband's doctor may not be able to talk to you. But the doctor can LISTEN to you. I would encourage you to write the doctor a letter with your husband's symptoms.

Also, are there any other family members you can recruit to help you with this? Sometimes if the spouse and the kids, and even others, like your husband's parents or sibling, can help.
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Re: How Much Is SA, How Much Is Depression?

Postby greatunclebill » Fri Jun 08, 2012 5:23 pm

ShelJT wrote: I feel sure that losing weight will work for him, though. We've been together for about 15 years now and he hasn't always had sleep apnea. He's always snored, but he didn't stop breathing. He gained weight, the snoring got worse and he started having trouble with waking up choking. It went away when he lost the weight last time. I feel certain that losing weight will improve his condition.


don't fool yourself into thinking weight loss will cure him. please don't do that. physical conditions don't get cured and not snoring or not gasping for air don't mean he doesn't still have apnea. remember this if you don't remember anything else: the only way to know if you have or don't have sleep apnea is through a sleep study. i hope the mother that cured herself by losing weight also had a follow-up sleep study to verify where she stands. sleep apnea in a very very high percentage of patients is a lifetime condition.

the physical condition that creates apnea often doesn't show up early in life. it's always been there, it just didn't create symptoms and problems til now. it's not a disease that you catch or cure. the narrow airway has always been there and will always be there.
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Re: How Much Is SA, How Much Is Depression?

Postby Dianne » Mon Jul 09, 2012 6:26 am

Did anyone mention a chin strap, to prevent air leaking out of his mouth? If you don't have a "seal", then the cpap/O2 is ineffective and the symptoms continue.
Dianne's: Remstar Auto M, C-flex, smart card. Mask: Swift LT. AHI- 23, lowest blood ox 80%.

John's: Resmed S8 Autoset II w/EPR, Mask: Respironics Profile-lite
severe apnea, Cpap user for more than 20 years.
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Re: How Much Is SA, How Much Is Depression?

Postby joand34 » Wed Aug 29, 2012 3:11 pm

I am not sure I am in the right place, as I am not a spouse, but the heartbroken Mom of a 54 year old victim of sleep apnea. . He was divorced, therefore I think your spouse is lucky to have a partner who is concerned, and can monitor them. As a psychologist, I know that anxiety and depression, alone, in a loved one is hard to deal with. I think my son's problems began with depression, and that medication (clonazipam), may have contributed to his death. Because of the medications, he gained weight. He was diagnosed at a sleep clinic, and had various machines, which were extremely uncomfortable, even painful.

My motivation in joining this site is to gain some consolation for the loss of my son, and to communicate to sufferers and their loved ones my feeling that there is a need to have health professionals (he was going to sleep specialists, a Psychiatrist, a dentist, and other physicians)to coordinate care. At least you can tell me if I am at the right plac
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Re: How Much Is SA, How Much Is Depression?

Postby Linda » Fri Aug 31, 2012 6:07 pm

Joand34,

I am so sorry for the loss of your son, I can't imagine your pain.

(You commented on a previous post here, so I left yours here, but your comments would be applicable in any of our forum sections).

You are so right that multiple-physician care should be coordinated, or better coordinated, particularly when there are powerful medications involved.

And followup care with sleep apnea patients could be handled better. Using the CPAP machines can be very hard for some patients, and not every person can be convinced to use the machine. But follow up care to find ways of treating the apnea really varies. I don't know your son's situation, how bad was his apnea, or what were his difficulties with using the machines, but I am so sorry none of that worked out.

Untreated sleep apnea can create depression, or it can make existing depression worse. And the serverity of apnea and how long untreated can be factors. There are no easy answers, but I agree physician coordination is so important. Whatever the situations were, your son certainly was going through a rough time. I'm so sorry. Thank you so much for sharing your story. And feel free to comment however you'd like.


Linda
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