I know, I know, I said that might be the end of the personal updates for a while. Well, turns out I’m just going to continue documenting my mental health journey for as long as medications and symptoms are changing. The former of which has happened.
Somewhat recently, during an intense emotional episode, I realized that I wasn’t breathing. I first noticed because my head and chest were beginning to hurt. This type of thing has happened before in the last year or two, where my breathing would be affected by my emotional state. When having a severe depressive episode, I would occasionally just… stop breathing. I attributed it to me simply not wanting to breathe because I was in pain. Not sure if that’s a normal cause of such a thing. In any case, I never thought much of it. But after this time, it kept happening even after the episode. I had to focus on my breathing for the next couple days or it would regularly stop.
Out of curiosity, I looked it up and found out that sleep apnea is just a particular type of apnea, which can happen when you’re awake. Since I had an appointment with my primary care physician in a few days after that anyway, I mentioned it to her. At this point, I had gradually noticed my sleep quality worsening. I wake up several times throughout the night–usually to use the bathroom, which has been for a few years now, so I never thought much of that part either–but people who experience sleep apnea don’t always realize that they woke up either, so it’s entirely possible I wake up more frequently without knowing.
I never feel rested when I wake up, which is a new thing for me in the last few months. Again, I only thought anything of it when I read about sleep apnea and realized that it could be causing my frequent headaches, which I thought were somehow related to my history of Chiari malformation and decompression surgery–which actually could contribute to me developing sleep apnea. I haven’t had a partner in bed for a few years now, so there hasn’t been anyone to notice if I stop breathing or even if I snore. So really all of these things possibly–emphasis on possibly–caused by sleep apnea were things I was accustomed to that I shrugged off by other explanations.
My PCP, given my history of Chiari, decided that a sleep study is in order, so now I have one of those scheduled for May. However, it doesn’t stop there.
I told my psychiatrist of this, since you should always keep your doctors up to date if they don’t do it themselves. He was more concerned than I thought he would be, and, in fact, we spent almost our entire appointment talking about this. According to him, with suspicion of sleep apnea, it would be wise to split up my latuda (antipsychotic) dose up in two, 60mg in the evening and 40mg in the morning, rather than an 80mg+20mg duo in the evening. He went on a whole ramble about it that I couldn’t remember, but I don’t think he truly explained more than it would be better to split it up if my PCP suspected sleep apnea because, if it acts as a sedative type of thing, it would worsen the sleep apnea. So we did that.
First–I did look it up, and from my place of ignorance, it sounds like latuda, as a medication that does tend to act as compared to a sedative, can make your throat muscles relax too much, worsening obstructive sleep apnea. I’m still not sure about central sleep apnea, as I don’t really know 100% what I read when I look it up, but it sounds like some medications–particularly antihistamines (like Zyrtec or Benadryl), benzodiazepines (like Valium or Xanax), barbiturates (like Fiorina or Pentothal), and opiates (like hydrocodone or morphine)–can make either obstructive or central sleep apnea worse by impacting your natural sleep cycle or breathing. I assume this type of logic applies across any medication that may worsen sleep apnea. In my case, my PCP and psychiatrist are suspicious of central sleep apnea due to my medical history.
Quick breakdown of sleep apnea: there is obstructive sleep apnea and there is central sleep apnea. Obstructive is basically a physical issue where air is unable to flow into the mouth or nose while you’re trying to breathe. Central sleep apnea happens when the brain is simply not sending the signals for you to breathe. Chiari malformation can cause sleep apnea via compression of the brainstem, damaging the nerves that cause you to breathe. It can also cause weakness to throat muscles, causing obstructive sleep apnea. I guess my doctors aren’t as concerned about that one?
Now onto how this dosage change has affected me so far. I just started the new dosages earlier this week, so I haven’t had too long to adjust. So far, I seem to feel more well-rested after waking up, I think. Not sure what that means. I have trouble getting back to sleep after I wake up, which still happens when I need to use the bathroom. Not sure what that means either. I feel tired a couple hours after taking my morning dose, which I had hoped wouldn’t happen, and that will be something I’ll have to call my psychiatrist about if it’s not a fluke. I haven’t been practicing very good sleep hygiene either, so I should fix that before I complain to him.
I’d been on the 80mg+20mg dose of latuda for a long time. I don’t really know why it would suddenly matter or why I would suddenly start developing sleep apnea, but I know it does happen, and my history of Chiari makes it more likely than without. So far the dosage change hasn’t caused anything overly negative, so for that I am thankful.