This post is by Bob Fiddaman.
The phrase “forty winks” can be traced back to Dr. William Kitchiner’s 1821 self-help guide, The Art of Invigorating and Prolonging Life.
The title is ironic given many users of antidepressants really don’t find that their medication invigorates or, indeed prolongs their lives, although many will argue that they prolong their lives because without them they would be dead. This is, of course, a strawman argument as nobody could possibly know if they would have lived or died without treatment unless they were privy to a special crystal ball or time-travelling DeLorean made by Doc Brown.
What does the term ‘forty winks‘ actually mean? Well, according to Wikipedia, a blink lasts for 300-400 milliseconds; if we surmise that a one-eyed wink lasts the same amount of time as a two-eyed blink, the duration of a “40 winks” nap would only be about 12-16 seconds.
I read with great interest Miranda Levy’s recent post, The Insomnia Diaries, It prompted me to leave a comment about my own lack of sleep problems whilst taking the SSRI Seroxat, known as Paxil in the US and Canada and Aropax in New Zealand and Australia.
People are often diagnosed with depressive illnesses when they proclaim to their GPs that they’re not sleeping. Their troubles are keeping them up at night and as a result they are missing out on an essential human function. Without, or not getting enough sleep, the brain cannot function properly. This, according to the Sleep Foundation website, can “impair your abilities to concentrate, think clearly, and process memories.”
When I was first prescribed Seroxat for work-related issues it helped me get a good-night’s sleep, bizarrely after waking, I never really felt refreshed. I was sleeping for longer periods than I had before so Seroxat must have been helping, right?
Well, the role of antidepressants is, in a nutshell, to make people forget their problems or, more importantly, not care about their problems. The longer you slumber, the more you are away from whatever is causing you concern. The longer you take an SSRI the more it strips you of your empathy so when you are awake you really don’t feel anything, it numbs your emotions. This is, more than likely, why Seroxat became a blockbuster drug during the 90’s. A drug that can make your worries and concerns disappear is magical but will eventually show you its darker side. It’s a bit like alcohol, another drug that people often turn to to ‘drown their sorrows’. It works but just like a lack of sleep and prolonged use of SSRIs can “impair your abilities to concentrate, think clearly, and process memories.
During my 6 years on Seroxat (the last 21 months seeing me try to taper off) I developed sleep apnoea , a condition where one stops breathing during sleep. Although I only had a mild case of apnoea it was deemed necessary that I use a sleep aid, a CPAP machine. Continuous positive airway pressure therapy machines help people, who have obstructive sleep apnoea, breathe more easily during sleep. A CPAP machine increases air pressure in your throat so that your airway doesn’t collapse when you breathe in.
It’s a bulky piece of machinery with a hose attachment on the end of which is a mask that one places over their mouth and nose. Luckily, for me at least, I lived alone. Inviting anyone back to share my bed was a big no-no. A machine and hose next to my side of the bed would have probably made anyone run a mile upon entering my bedroom.
It’s a frustrating piece of equipment but, I was told, essential in helping me get a refreshing sleep. I’d often wake to the mask pointing at me on my pillow bellowing out air after it had fallen off during my tossing and turning. It actually made for a great air conditioning tool as, at the time, it was a particularly hot summer.
One morning I woke up frustrated and angry, the machine had pulled away from the side table. I picked it up and threw it against the wall. It shattered into many pieces. I then returned to my Seroxat induced, albeit broken, slumber.
More appointment letters arrived from the sleep clinic. They wanted to know how I was progressing. I ignored the letters, I didn’t have the heart to tell them that the CPAP machine was now stashed away in my wardrobe in a black bin-liner bag…in numerous pieces.
I persevered and gradually started exercising, walking with my dog 5 miles every morning. The weight I had gained whilst on Seroxat soon fell off and the exercise made me physically rather than mentally tired and, from that, I was rewarded with a ‘normal’ sleep.
During my withdrawal period my sleep problems returned, although this time I was more concerned about my sanity rather than stopping breathing during sleep. I’d often wake in pools of sweat after having truly horrific nightmares. I was only withdrawing 0.5mg per week, nonetheless this caused me severe sleep problems. Once I decided to go cold turkey (after 19 months of dropping 0.5mg per week) that’s when the problems really started. I’d position myself in a foetal position when going to bed at night, preparing myself for the onslaught of head and body zaps that Seroxat causes when missing or stopping a dose.
I remember one night in particular. I woke up, at least I think I did, pinned to my bed. It was like an invisible force was holding me down. Was I dreaming? I remember having the thought to scream out to break my ‘dream’ but I could not do this. My mouth would open but no noise could be made. There was also a terrible sense of dread, like there was some demon in my room that had come to visit me, maybe kill me. I was pinned, voiceless and at the mercy of whatever it was that was in my presence.
Turns out it was a condition known as sleep paralysis, it is thought to be precipitated by sleep deprivation, stress, and sleep schedule disruption.
It was a merry-go-round that wasn’t very merry at all.
Great! Seroxat gave me apnea. I come off it and am left with sleep paralysis. Remember, previous to my Seroxat prescription I couldn’t sleep because I had work-related issues on my mind. This was now 6 years ago and the work issues had been resolved. However, from not being able to sleep because ‘something was on my mind’ to not being able to sleep because of breathing obstructions and withdrawing from a drug that was prescribed to help me, I was now in a far more precarious position than I was pre-Seroxat.
I wouldn’t recommend anyone take Seroxat, in fact it’s rarely prescribed these days because of the problems people have faced when taking it. I was one of those people, a guinea pig, if you will, for the post-marketing teams at the drug company and medicine regulator, you know, those teams who file reports then dismiss them as not being drug-related.
So, having been free from Seroxat for over 15 years, what is my sleep like now? It’s decent. Sure, I have things that swim around in my mind as I lay down at night but they last just a few minutes.
The one thing, however, this whole experience has left me with is my inability to get back to sleep once I wake. Once I wake, I’m up. Nothing keeps me from dropping back to sleep, nothing that is on my mind anyhow. It’s just that my body-clock has changed, hardly surprising given the 6 years of swallowing a chemical that has probably re-designed the way my brain works.
There are reports to regulatory bodies regarding SSRIs causing sleep-related problems. The details for Seroxat are below. A table next week will give details for all common antidepressants.
Although the figures may seem low, this is just what has been reported. There are many hundreds of thousands of people out there who are struggling with sleep. They may not know, or have made the connection, that the SSRI they are on may be keeping them from having an invigorating and Prolonging Life.
The number 9 here means the 9th most commonly reported problem. The figure 3351 means the number of reports and 4.55% means the proportion this is of all reports.
Author, blogger, researcher
To be continued..