How has sleep apnea affected you cognitively or emotionally?
October 21, 2016 3:03 PM   Subscribe

My partner was diagnosed with sleep apnea 18 months ago. He became somewhat emotionally unstable around the same time. It's time to put my foot down and insist that he seek treatment for the apnea. I'm wondering whether I need to ask him to seek separate treatment for the emotional issues--which would be an extremely hard sell--or whether those are likely to improve if the apnea is treated.

After a sleep lab, he was diagnosed with moderate obstructive sleep apnea and was supposed to come back for a second night to have a CPAP fitted and calibrated, but he never scheduled the follow-up.

About the same time that the incredibly loud snoring started, I noticed several cognitive and emotional issues. They could just be normal moodiness or stress, but I never saw them in the two years I knew him before the snoring started.

He has flown into a few screaming rages at me and others that were way out of proportion to what the other person said/did, including one outburst that nearly cost him his job. He began taking a lot of things personally, such as getting very upset about a facial expression or off-hand remark that has little or nothing to do with him. (For example, when a scheduling error reduced attendance at one of his work events, he assumed that it was done intentionally to slight him despite having no conflict with the person who made the error.) He became very sexually demanding, not in terms of demanding sex with unusual frequency, but in terms of being very pushy and angry when it's been more than a few days, even when I was pregnant/breastfeeding and generally sleep-deprived and miserable. He also became just plain grumpier in a thousand small ways: groaning and grimacing frequently; slamming cabinet doors; stomping rather than walking, etc.

I'm seeking anecdata from apnea sufferers or their family members about any emotional side-effects they experienced and whether those issues resolved themselves when the apnea was treated. I've been able to find good information on the comorbidity of sleep apnea and depression, but I'm not sure whether these behaviors are likely to be depression, especially since he does not seem to have most of the common symptoms.

He is not thrilled about getting a CPAP, but he's much more open to that than to seeking traditional treatment for depression or other emotional issues. (He's open to herbal treatments, acupuncture, etc., but he's already doing those things and he's still hell to live with sometimes.)

I don't think he'll agree to therapy and/or medication for the emotional issues unless I threaten to divorce him over it. I would do that if necessary--and I would indeed leave in a heartbeat if he ever treats our toddler like he sometimes treats me--but I can cope with it for six months or a year if these issues are likely to improve when the sleep apnea is treated. While I find some of his behavior unacceptable and borderline abusive, I also know how miserable I was when our kid was waking up several times every night, so I can only imagine how waking dozens of times per night due to apnea might be affecting him.
posted by anonymous to Health & Fitness (17 answers total) 9 users marked this as a favorite
A friend was recently diagnosed with sleep apnea- and ey is so much happier with the machine. (Parent passed away, new child masked the intensity of the symptoms.)

Lack of sleep impairs cognition. You see this in the overly emotional responses, the 'not coping'. Lack of sleep leads to irritability.

Even after one sleep on the CPAP ey felt amazing. You can always try different masks until you find one that works, or of course you could stop using it!

Get the follow up. Sleep apnea isn't just snoring, it could be stopping breathing in his sleep.

As to how to get him to do this when he's cranky I don't know, but watching the circles under my friend's eyes disappear was amazing.
posted by freethefeet at 3:18 PM on October 21, 2016

Hosehead here! Getting a CPAP changed my life. I was on several medications for "bipolar depression" and have gone off all of them. I took a cocktail of sleep meds because I had "insomnia" and now just take melatonin and an occasional Ambien. What I thought was mental illness was sleep deprivation.

I never flew into rages, but I had mood swings, memory problems, was tired and irritable all the time. I had such a hard time focusing. Now I'm so much more calm and energetic.

My case was particularly severe - I stopped breathing something like 60 times an hour - and went undiagnosed for a long time because I do not fit the conventional profile of an apneic. But I got my CPAP and never looked back. I use a nasal mask, a mask liner, and a heated humidifier; I have a friend who uses nasal pillows and loves them. It's harder if you need a full-face mask; many people prefer using a nasal mask and a chin strap. At any rate, most people need to try a couple of masks in order to get a perfect fit.

You mentioned kids. Sleep apnea greatly increases car accident risk. If he were my partner, I'd be afraid of him driving drowsy with kids in the car! Sleep apnea also ups the risk of heart attack and stroke. Your partner shouldn't put his kids at risk of losing their dad at a young age from a heart attack.

Tell your partner to get his goddamn CPAP titration. If you need to, PM me his email and I will tell him myself how much better I feel and what a difference this has made in my life. I am that serious about it.
posted by Rosie M. Banks at 3:27 PM on October 21, 2016 [7 favorites]

You really have to treat the physical issue first. Oxygen deprivation and sleep deprivation are, like, life-threatening to self and others in the way that moderate-if-unpleasant mood issues are not.

Literally get him to put his mask on first before addressing anything else. Worry about the rest later.
posted by Lyn Never at 3:42 PM on October 21, 2016 [1 favorite]

I'm a sleep medicine PA. It is common for me to have my patients tell me on their first visit after starting treatment for OSA that their moods have significantly improved.
posted by teamnap at 4:06 PM on October 21, 2016 [1 favorite]

I got diagnosed with relatively bad sleep apnea, and haven't spent a night without my CPAP since I got it fitted. It is seriously the biggest single life change I have had - no medication/other therapy has come close. Lack of sleep is SUCH a huge factor in making every other little thing worse. Was able to ditch a few meds, am not tired all the time- it's amazing.

I know not everyone has quite the huge improvement I did, but the change in quality of life is so huge that I get Actually Upset at people who won't treat it! Argh!
posted by AaronRaphael at 4:10 PM on October 21, 2016 [2 favorites]

OMG, yes. This is worth an ultimatum. Get that second appointment ASAP. I'm sorry you're dealing with this. It's an unacceptable situation and given that there is at least one issue that can easily and immediately be rectified, do that one.
posted by amanda at 4:12 PM on October 21, 2016

My dad had awful apnea — his doctors woke him up from his first sleep study because he stopped breathing so long and so often they were afraid he'd die on the table.

He never did get a CPAP, but he did lose 40 lbs of bellyweight which significantly reduced his snoring and upped his sleep game. Before that he was irritable, moody and punitive, prone to bizarre leaps of logic and fits of rage. Afterward he was just moody.

FYI, he nearly lost his job as a professional driver by losing control while micro-dozing at the wheel. He could have killed himself and somebody else too. Don't wait.
posted by fritillary at 4:35 PM on October 21, 2016 [2 favorites]

Sideways answer: try to find out if he's a candidate for a dental appliance. I have mild OSA and I got one. I couldn't tolerate the CPAP I tried for the moderate relief it gave me, but I sleep with my mouth widget every night with no trouble (compliance rates are higher than CPAP, my sleep dentist says) and my insurance covered most of it.
posted by clavicle at 4:46 PM on October 21, 2016

My psych and the rest of the professionals in her office (mostly they treat men, or new mamas) have a low key demand that everyone get tested for sleep disorders. Particularly men who snore - it has demonstrated psychological effects.
posted by geek anachronism at 5:37 PM on October 21, 2016

I tested negative for apnea but I do have chronic insomnia. When I'm not sleeping right I absolutely have worse depression symptoms and just general problems coping with stress.
posted by The Underpants Monster at 6:23 PM on October 21, 2016

Noticeable change in my husband's behavior and moods once he got his CPAP. He became so much easier to deal with and as a bonus, I could sleep again since I didn't have to elbow him every 3 minutes to get him breathing again. I had to issue an ultimatum for the sleep studyand once he realized he was literally killing his brain, he started using a cpap every single night. No exceptions.
posted by PorcineWithMe at 7:07 PM on October 21, 2016

My husband has had a CPAP for 8 years. It took about a month to get used to it, but as soon as he adjusted, it changed his life. He stabilized. He was less grumpy, he was less mean, he was friendly, he was interested in the world, he was open to other people. It was astonishing. It was like I had my sweet prince back.

The night he had his sleep study, he went to the hospital and they hooked him to the machine. They monitored him all night -- and they woke him up every 2 hours to adjust the machines they had him attached to. And when he was done, he got dressed, bought donuts, came home, and was the nicest to me that he'd been in years. It was like his own self had come back. I can't overstate how important to him this was, and how important to our marriage it was.
posted by OrangeDisk at 8:40 PM on October 21, 2016 [2 favorites]

I feel so much better after getting a CPAP. I was a mess for a couple years--just exhausted all the time. I feel great now! I have the nasal pillow system, which I prefer to the full mask.
posted by persona au gratin at 2:41 AM on October 22, 2016

I wouldn't say I was clinically depressed, more like dysthymic. Once I started using a CPAP machine my wife said I definitely seemed happier. I don't think CPAP can fix things by itself - I think your partner is going to have to spend some time with therapy as well, but it does help.

I use a full face mask and every night I think to myself that there's no way I can sleep with it on and every night I pass out pretty quickly. I can't use a nose-only mask because my mouth falls open all the time and I don't want to use a headband to keep it closed. I guess I'm a nighttime mouth-breather. But it's surprising how quickly I got used to it and how used to it I am now.
posted by GuyZero at 9:40 AM on October 22, 2016

Also a 'hosehead'* here.
Agree wth all of the above re: adequite sleep absolutely necessary for control and sane behavior, but suggest you evaluate once the physical issue is addressed. You may decide that emotional issues need to be addressed as this seems to indicate a lack of tools in the behavioral toolbox. You both might be happier once this is fixed, as it may be a reoccuring behavior under stress.
posted by BlueHorse at 2:33 PM on October 22, 2016

Depending on how irritable and mean he is - it can definitely be a vast improvement. I had a boss who was utterly unbearable for most people (some of us were apparently able to tolerate it). He got a CPAP and the difference in anger and rage was like night and day. He still had the core of those issues, but he managed it better.

He DEFINITELY needs more therapy, but that wasn't gonna happen.

Either way, do it. I have a CPAP, but I'm also medicated for anxiety. I'm not sure how much does what, but I'm sure the CPAP plays a role in keeping me not constantly tired and needing a nap right after I come home. I still nap once in a while, but it used to be constant napping. I have had plenty of rage issues as well.

I'd recommend CPAP to see whether that's the sole cause, or how much it reduces the anger/anxiety issues. If there are still issues after that, he may at least be more amenable to the idea of therapy/meds once he's actually reduced the lack-of-sleep rage.

Good luck!
posted by symbioid at 6:47 PM on October 22, 2016

Even if the CPAP doesn't completely fix his emotional issues, it's likely to give him enough relief from the terribleness of sleep deprivation that the discussion of further treatments may be easier.

CPAP is amazing. There is a lifechanging difference between "I think I'm fine because I'm used to feeling terrible" and "I actually feel fine."
posted by oblique red at 10:26 AM on October 25, 2016

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