The Vicious Cycle Linking Depression, Insomnia, and Apnea

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I’ve been suffering from insomnia for a couple of years. I can fall asleep but have trouble staying asleep. I typically wake up around 2 AM and cannot get back to sleep. I’ve tolerated it this long because the sleep deprivation has not had a negative effect on my life.

However, since starting my new job this past January as a clinical supervisor, I’ve been working longer hours than ever. I start at 8 AM and go through to seeing clients in the early evenings and then I need to write notes. It’s a long day and I start to feel the effects of not having slept the night before.

It’s a vicious cycle because when I finally get off work, I’m exhausted. Having usually eaten at my desk, I take my dog, Shelby, for her last walk of the night, check my personal emails to see if there is anything pressing and despite myself, sometimes nod off.

I wrote in a recent post about feeling as though I’ve been dealing with a high-functioning depression since the beginning of the year. There is an established link between depression and sleep deprivation. One study from 2015 states, “There is a strong bi-directional relationship between sleep deprivation/disturbance and depression. Although disturbed sleep is associated with psychiatric disorders and is traditionally considered to be a symptom of depression, research suggests that the relationship between sleep changes and mood disorders may work in the other direction as well.”

The exhaustion at the end of the day — and sometimes earlier — prompted me to see a sleep specialist. She recommended a sleep study in a sleep lab, but my insurance would only initially approve a home sleep study. That study showed that my oxygen level dropped below 88% for 129 minutes and the lowest it reached was 83%. That was enough to get a sleep study in a lab approved. In that sleep study (of course) I slept until 5 AM, but more importantly it showed that I had sleep apnea, which was a surprise to my doctor and to me. I have none of the risk factors, which include being male, being overweight, family history, large tonsils, a thick neck, heart or kidney failure, or lifestyle habits such as drinking alcohol and smoking.

I feel as though I’m getting beaten down from two sides of not the same, but related coins — there is also a link between depression and sleep apnea. One study states, “MDD [major depressive disorder] carries with it an 18% prevalence of associated OSA; OSA has a 17.6% prevalence of MDD. There is a co-linear relationship between OSA and MDD. Both conditions present with common mood symptoms, anxiety, restlessness, fatigue, and poor concentration.”

Source: © cpap-com

Now I am trying to get used to sleeping with a CPAP machine, which is not easy. I am — or should I say, I used to be — a stomach sleeper which is no longer possible. Advances have been made in equipment so there are options available other than a full-face mask. What I use is called a pillow mask which consists of two nasal prongs — larger than the ones that deliver oxygen. They blow air up your nostrils all night, delivering a continuous stream of air. The newest CPAP machines are programmable, so that when you go to sleep and turn them on, they ramp up slowly, meaning they don’t go to the full force of the air right away. The idea is that they give you time to fall asleep so you don’t feel the full blast of air.

I’ve read articles and watched YouTube videos about adjusting to a CPAP machine, making friends with it, and getting the most out of it and still we remain enemies. I dread going to bed. Feeling that continuous blast of air up my nostrils is uncomfortable and disconcerting. I’ve read about how people with sleep apnea use the CPAP and miraculously sleep for eight hours and wake up feeling refreshed for the first time in years. Not me.

To make matters worse, my usage is being tracked by my insurance company and the durable medical equipment company that is renting the machine to my insurance company on my behalf. I was informed that the insurance company doesn’t want to outright purchase the machine until they can ensure I’m using it. Fair enough. The data has to show I use it for at least four hours per night for 10 months before the insurance will purchase the machine for me. I’m not sure if I’m meeting that criteria.

Thanks for reading.