Depression, Fatigue, Apnea

[Guest guest]

Rob, it sounds as if you experience many of the issues which I do. It can be a

bewildering task to sort it all out. Perhaps by my sharing a bit

of the process I have gone through, you may continue to have hope and to

persevere. I think perseverance is perhaps the single most important

attribute one can have (after the desire to be healthy) in making progress when

you have so many separate -- but often intertwined -- health issues.

I have suffered from depression all of my life. When I was young, my parents

really did nothing to address the issue. It wasn't till I was going

through separation and divorce at age 36 that I started treating my self

seriously -- with medication and therapy at a licensed psychologist. Both

were very helpful, though it did take some time to deal with the many issues and

to find the best medication for me. All of this continued with

much success for some years until I discovered at age 41 that I have CMT1A.

This, of course, brought on its own emotional issues to deal with --

but also provided a great deal of understanding and relief. Part of that relief

stems from realizing the interplay between fatigue and depression

-- and how it is, as you wrote, very difficult to tell which comes first. The

answer, I think, is that it largely doesn't matter. It IS important,

though, to interrupt the cycle, address both issues with knowledge, wisdom, and

professional help -- and start reversing the downward spiral. For

me, the most recent step in this journey came about a year ago when I finally

succeeded in convincing my family doctor that I should have a sleep

study done. I've always had some difficulty sleeping but it had gotten much

worse when my divorce was in process. As it turns out, I have 3

scientifically diagnosed sleep disorders: 1. Narcolepsy 2. Moderate Sleep

Apnea 3. Bruxism (teeth grinding). The picture certainly became more

complex, but it also became more clear. For me the combination of:

A.(undiagnosed) depression, B. (undiagnosed) CMT, and C. (undiagnosed)

multiple sleep disorders for most of my 44 years have most certainly contributed

-- in unhealthy ways -- to each other. They also have all combined

to manifest themselves in my body, mind, and spirit as depression, fatigue,

tremors, weakness, irritability, chronic pain of varying degrees,

under-achievment, frayed relationships, frustration, sexual dysfunction and

occasionally, anger. That's more than enough to make most people

depressed, I think! The good news is that as I have identified and dealt with

all of these issues, I see progress. No, CMT progession has not been

reversed (though there is good reason to hope for that as we have all recently

been reading). But with careful consultation with physicians who

take me seriously, educating myself as much as I am able, and listening to what

my body is trying to tell me, I am clearly making progress. And

despite the difficult things I listed above, I DO enjoy my life: I have

fulfilling relationships, am employed full-time in work I enjoy, am

physically active working on my house, canoeing, dog-training, etc.

A word or two about apnea. None of us can live (at least for very long) without

water, food and sleep. Even the most healthy people need to have

good sleep. People with chronic diseases like us have an even greater need for

good sleep. Any lack of oxygen intake -- besides interrupting your

sleep -- also contributes greatly to fatigue, depression and pain, among other

things. My case of Obstructive Sleep Apnea (OSA) is a moderate one.

A few months ago I was fitted with a customized device to wear in my mouth when

asleep. This type of device is called by various names: madibular

repositioning device, Silencer, adjustable lower jaw device, etc. It has been

shown to be quite successful on many people with mild to moderate

cases of OSA. I have had a definite improvement in my sleep, pain and fatigue

issues since I started wearing this device. One of the reasons it is

so helpful for many people is that it is more likely to be used consistently

than CPAP machines (for obvious reasons). Unfortunately, it is not

shown to be helpful with severe cases of OSA. It sounds to me as if your case

IS severe. Oxygen levels as low as 35% are dangerous. The CPAP

machine, adjusted properly AND WORN CONSISTENLY can literally be a life-saver

for you. Weight loss can only help, as well. If you haven't already,

seek guidance on diet and moderate excercise. Don't over-do the excercise.

You wondered if CMT has anything to do with OSA. My best guess is that most

medical professionals would say a direct physiological link is

unlikely. In rare cases, CMT can affect the phrenic nerve which operates the

diaphram, which in turn affects breathing. OSA itself, to my

knowledge, doesn't have to do with the diaphram, though. Apnea and CMT CAN be

related in the way you described in your posting about lowering your

activity level because of CMT, and gaining weight. And, of course, not sleeping

well reduces your energy level and exacerbates your CMT symptoms.

All of this brings me back to what I wrote earlier: Keep paying attention to

your body; address each issue the best way you know; and keep at it as

best you can. Also; Keep wearing the CPAP machine! Oh, and most importantly:

Give yourself a break! Regularly.

Best wishes,

..

Mark T Fulton

" In a full heart there is room for everything, and in an empty heart there is

room for nothing. " Porchia