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Ssri Antidepressants & The Mslt

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#1 mollygail



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Posted 06 June 2013 - 01:20 AM

I was wondering if anyone else has experience with SSRIs and N. I've been taking Lexapro for 4 years, but my EDS predates that. I finally had a PSG and MSLT on Monday, and my mean sleep latency was 4.5 minutes, which could be either N or idiopathic hypersomnia. I didn't go into REM on the naps or within the first 3 hours of my night sleep, but the tech told me that SSRIs are REM inhibitors which might be why I didn't have REM. My own instincts tell me that IH might be a better diagnosis (long sleep, unrefreshing naps, sleep drunkeness) but I also have N symptoms like pre-sleep hallucinations (whatever those are called), sleep paralysis, and constant hypnagogic jerks. I'm seeing the sleep doctor tomorrow to discuss the test but I was wondering if anyone else had experience with SSRIs inhibiting REM.

#2 lkl



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Posted 06 June 2013 - 05:30 AM

SSRIs can definitely reduce REM sleep. Without having another PSG/MSLT after being off Lexapro for a few weeks, you can't really know if you would have otherwise gone into REM in the naps or not. But narcolepsy and idiopathic hypersomnia are treated in pretty much the same way anyway, so you might not need to have another sleep study.

#3 MINItron



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Posted 06 June 2013 - 08:11 AM

SSRIs are specifically prescribed to narcoleptics for the reduction of REM. The sleep study protocol indicates that you should be clear of such medications. Having been on it for 4 years would require a long taper, and there is a strong possibility of REM rebound. Hypnagogic hallucinations and sleep paralysis are not exclusive to Narcolepsy. They can occur in anyone who is overly tired no matter the cause, and I have never heard of hypnagogic jerks being a symptom of Narcolepsy at all.

#4 Hank



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Posted 06 June 2013 - 08:47 AM

Hypnic jerks, also known as Periodic Limb Movements of Sleep (PLMS) are common in people who are sleep deprived, including Narcolepsy. It is not diagnostic of Narcolepsy, but a common symptom.

For me, PLMS were the most noticeable abnormality on my first PSG. Unfortunately, the doctor stopped there and that was eventually made into my primary diagnosis.

Several years later with losts of persistance, I was accurately diagnosed with Narcolepsy with Cataplexy. But Cataplexy was the clincher. Without Cataplexy, the treatments are essentially the same, whether IH or N.

So, unless you have Cataplexy, you will need to judge how hard you want to push through to a definitive diagnosis. The best you can hope for is symptomatic relief of your daytime sleepiness and disturbed nighttime sleep, regardless of the true cause.

So, is discontinuing Lexapro and repeating the tests worth it to you? Is the juice worth the squeeze, so to speak. You and your doctor will need to discuss this. As long as your symptoms are taken seriously and you are listened to- and your symptoms are effectively relieved, you should be on the right track.