I had been complaining about sleep problems for several years with my doc not taking me seriously.  I switched docs and had a sleep study done.  Found out yesterday that I do have apnea.   She told me that before I have the titration(?) study done, I have to get off paxil which I have been taking for the past several years also.  I am wondering now if I had anxiety possibly because of the apnea and it was not caught.  

It is going to take me several weeks to wean from the paxil and they want me off of it for 4 weeks before they will do the titration test.  Does this sound normal?  I don't want to wait that long for some sleep!

I also notice that gerd is a symptom and have also been treated for this the past several years.  I really feel like my doc missed the boat diagnosing me.

Any extra advice?

I am surprised at the request to discontinue Paxil for the Titration study, as I am not aware of it affecting the collapsibility/pressure requirements needed.  I have heard narcotic pain med's, muscle relaxants, etc can cause us to need a higher pressue.  I would think that an antidepressant might effect sleep architecture, but not airway patency.

Another thing I would question is the advisability of stopping a long term prescription suddenly, vs a gradual reduction in daily dosage over a period of time.  This might be worth discussing with your physician and/or a pharmacist.

And yes, untreated apnea can contribute to both anxiety and depression as well as gerd.

Hi Nicemom,

Well, I've had five sleep studies over the course of several years in two different sleep labs with different doctors, on all kinds of meds., including psychotropic and no one has ever told me to stop any of my meds.  Your study showed apnea, you currently need Paxil.  A titration study simply tells them where to put the CPAP pressure to overcome your apnea.  

Urggg, tell them to do the study pronto or find another lab and have your results sent there.  You are the patient, they work for you!!    In my opinion, it would be a huge disservice to you to not do the titration study immediately and to put you through the grief of getting off your meds for no good reason.

Vicki

to nicemom

I cant see why paxil would need to be stopped either , its just 1 of many prozac type meds  but   paxil can be quite difficult to quit, see paxil discontinuation syndrome on the net via a search engine

She said the reason they want me off the paxil is because paxil inhibits the last two cycles of sleep.  According the my sleep study I never reach the third and fourth cycles.   I am weaning off of it over a two week period and she has added effexor instead.  I am building up on the effexorover the two week period that i am weaning off the paxil.  I only started yesterday and hope it all goes well.   I really do not want to be on it anymore so I am glad to be weaning off.  Once I get my sleep problem solved i will get off the effexor also i hope.

Because of what she said about the paxil it makes me wonder if my sleep apnea is caused in part by the paxil.

Per suggestion from a friend I called the local medical supply company and am inquiring about a c-papp machine I was told they have that is self adjusting.  She told me they let you have it for free for two weeks and will tell you what the readout says afterward to you know what your settings should be.  Of course they want you to buy the c-papp machine there and that is why they do it.   Has anyone ever done this instead of having the titration done?   I have really !@#! insurance and the sleep study was over $4000.

Diane, Ohio

I don't know if it inhibits sleep cycles (anyone know so I don't have to search for the answer?).  But it seems that if that were the case, there would be an awfully lot of sleep deprived depressed people.  Well OK, there are a lot of sleep deprived depressed people, but I digress.  Anyway paxil may disrupt your sleep cycle, but don't confuse sleep cycle disruption with obstructive sleep apnea (OSA) which is sleep disrupted by a physically blocked airway.

The only way to fully diagnose sleep disorders is by a sleep study and professionally titering out the corrective air pressure to use if OSA is the diagnosis.  A lot can be missed by simply taking home a machine.  When you have an overnight study, you are wired for sound, EEG, EKG, leg movements, breath, snore, chest movement, I know I'm leaving something out.  $4000 seems high for a sleep study (SleepyDave what is the norm?).  Can you comparative shop around for the best price?

Vicki

Hi Diane!
You know, I read these posts and I'm as confused as you all are.  If there was one "better" answer, it would be be:  Go back to your doctor and say "Hah?"
Pharmacy is somewhat out of the scope or ability of this forum, so take everything you read here with a grain of salt.  That goes for me, too.  That said:

Read my little blurb about sleep architecture:
Sleep Architecture
There's a big difference between sleep cycles and sleep stages.  Drugs usually disrupt sleep stages, not cycles, and even if they do we don't describe it that way. Also because drug effect wears off over a period of time, the earlier cycles are affected more than the later.  Which is probably the case with Paxil, which tends to be a REM suppressant, resulting in missing REM cycles and decreasing overall REM sleep.  And surprise! Guess what Effexor does?  Right, same thing.  So I don't know what the point of the change is.
There is one anectdotal reference about Paxil and OSA, which suggests it may actually improve OSA:

Quote:

One study investigated the effects of the antidepressant paroxetine (Paxil) on patients with obstructive sleep apnea. The agent improved breathing during late sleep stages but had little effect on other aspects of obstructive sleep apnea

I can't find the original article, so I can't tell you anything more than that, and I really doubt that the improvement was anything significant.
If you get your sleep study results, including the histogram like the one in the post above, perhaps we can find out a little more info.
To repeat, don't throw all the medications out the window because of something you read on sleep apnea forum.  But I hope this will allow you to ask informed questions.
Oh yeah, price of studies varies by region, but most areas seem to be in the 2000's.  The "billed" price may be academic if your insurer has a "negotiated" price with the sleep laboratory or hospital.
If your apnea is severe, I think any benefit from waiting for a medication change effect is far outweighed by the effects of the OSA.
sleepydave

I have both of these and was not told to stop the paxil prior to the study. I too think that the apnea brought on the anxiety. The doctor told me to raise the head of my bed up for relief of the reflux. This has helped. I  am having trouble with the CPCP though. I've had anxiety problems for over 20 years and probably the apnea for the same amount of time although it was just diagnosed. Goo luck.

I meant to post as a new topic and accidentally posted here.  I am sorry.


_________________
Thomas Vaughan

I think you need to do some more research.  At http://www.umm.edu/patiented/articles_seep_apnea_O  and then I don't have the rest of the address there is mention that "One study investigated the effects of the antidepressent Paxil on patients with OSA.  The agent improved breathing during late sleep stages but had little effect on other aspects of obstructive sleep apnea."

I have not found the original source or study but this quote is on the University of Maryland Medical Center - Home-Medical Reference-Patient education-How serious is sleep Apnea?

My gut says not to stop taking the paxil.  Remember docs like to have clean data and the paxil might somehow affect the data; however, if it is normal for  you to take paxil, then the test should be with the paxil because after they do the studies your results might not be what is expected due to the paxil.  I believe in doing things the way they are in the real world and not necessarily under an artificial situation.  Good luck

Ray

I too was diagnosed with sleep apnea (moderate) just last night, at a clinic. I too am taking 30 mg of paxil a day. I have to go back for further testing soon. I hope they don't ask me to go off paxil. I will let you know.