Dr. Ashok Kumar
Geriatrics
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Patient's Query
Hello doctor,
I am suffering from sleep apnea and some psychological problems. I strongly suspect that the two are related and that sleep apnea is causing psychological problems. About four years back, I was diagnosed with sleep apnea when the AHI was around 30. Gradually, my weight increased over a period of time, and this increased the severity of the sleep apnea as well. Even though I use the CPAP machine, I get an AHI in the range of 8 to 15 only. Generally, if I have a good sleep, I feel fresh in the morning but a bit lethargic and drowsy in the afternoon. In the evenings, I become active again. Because I feel active in the evenings and at night, I find it difficult to sleep. Sometimes thinking and worrying about things disturbs my sleep at night. But if I do not sleep early enough, I do not get enough sleep and feel bad the next day. As my weight and sleep apnea severity increased, I started experiencing some psychological problems as well. They are as follows: Anxiety and worry about low probable situations and what-if kind of scenarios. Sometimes anxiety causes brooding, which causes more anxiety which again causes more brooding. This vicious cycle leaves me feeling completely demotivated. Lack of ability to think clearly and analyze things to their logical conclusion (Muddled thinking). Mood fluctuations. Not able to constantly maintain a happy mood. 'Feel good' happens only sometimes. Sometimes, I feel demotivated to go for a daily walk. Worries impact the ability to stay motivated and positive all the time. Imagining worst-case scenarios instead of optimistic and positive thinking. Social problems and inability to deal properly with people. Can you please help me with my problem?
Hi,
Welcome to icliniq.com.
I read your query and understood your concerns. With available details, it is almost transparent that you are suffering from sleep apnea and secondary mixed anxiety-depressive disorder (MADD), which means sleep apnea itself causes anxiety and mood depression. Now regarding the treatment, I suggest one of the following strategies. Treatment of sleep apnea and psychotherapy for anxiety and depression. Treatment of sleep apnea and pharmacotherapy (medications) for anxiety and depression. Exercise regimen to control both sleep apnea and anxiety, and depression. Among the available options, you should explore the first option as it has a better outcome with limited or no side effects. I suggest tablet Armodafinil or Modafinil for sleep apnea and cognitive behavior therapy for anxiety and depression before exploring the other two options. In my opinion, using CBT (cognitive behavior therapy) for anxiety and depression will relieve you from these ailments and will give better energy to deal with sleep apnea. At the same time, tablet Modafinil or Armodafinil will help to reduce sleep apnea before the effect of exercise takes place. I must also acknowledge that what doctors say about sleep apnea is correct, but it is not easy when someone suffers from anxiety and depression. Once treatment for sleep apnea is started, psychological problems will also subside, as it is secondary to sleep apnea. I hope this helps you. Feel free to write back to me if you have more questions. Thanks and regards.
Patient's Query
Hello Doctor,
Thank you for your informative response. I wanted to know how serious is the problem? Currently, I am working as a software development engineer in an IT company. Due to the covid-19 situation, I am working from home. I wanted to know, do you think it is better if I resigned from my job? I may be able to focus better on improving my health. Sometimes, work related tensions and pressure can add to the problems. Also sometimes due to excessive work I have to skip exercise. But on the positive side, work keeps my mind engaged.
Hi,
Welcome back to icliniq.com.
Thanks for follow up and relevant questions. My answer to your queries are as follows. Although afternoon nap is good option but the power nap should be limited to 30 minutes or maximum 45 minutes. In absence of so, the effect decreases over time and there may be problem with night sleep after some time. As suggested this is definitely better solution if helpful provided appropriate concerns are taken care off. Fortunately this is safest way to treat OSA. In fact rather than risk, it comes with multiple bonuses in form of improved cardiovascular health, muscle health, metabolic health among others. The natural treatment can be helpful but not effective to a great extent. I hope this answers you. Feel free to write back to me if you have more questions. Thanks and regards.
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Geriatrics
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