Quetiapine and sleep apnea

[Ktulu]

I've been taking quetiapine at varying doses for 5 years. I'm currently taking 400mg at night. I also started taking a blood pressure tablet about a month ago. If I take the two together (I take all my meds at night and sometimes forget to take the BP tablet in the morning), my heart starts pounding and I get a little short of breath. I really thought I was imagining it or that it was anxiety, but it doesn't happen if I take them separately or if I reduce my quetiapine to 200mg.

The other problem is that I seem to be having sleep apnea just after I fall asleep. It happened again last night 15 minutes after I fell asleep. I woke up cos I could feel I wasn't breathing and felt like my airways were collapsing from lack of air. This triggered a massive panic attack. It only happens just after I fall asleep and doesn't happen every night. I think it is dose dependent because I don't think it happened before my dose was increased from 100mg to 400mg last October. Has this happened to anyone else? I know I'm not imagining it because there seems to be a clear link to the quetiapine, but it just seems so strange that it's happening after being on it for so long that I'm doubting myself. Has this ever happened to anyone else? I know I'll probably have to come off it which is very disappointing because it's been a massive help to me.

[Epicene]

Have you gained weight on quetiapine? It could be that weight gain is causing it if you are overweight. A similar thing happens to me, and it is frustrating because the quetiapine led to me gaining weight. So it might indeed be the medication but secondary to the medication itself.

[Ktulu]

I am overweight but it's been consistent since about a year after starting quetiapine and I've been losing weight, albeit slowly, for the last number of months. There are some reports of people developing sleep apnea on quetiapine but not much info on it. I don't have a psychiatrist at the moment because she retired and I haven't had the need to see one since so I'm relying on my GP, who is lovely but not great on mental health. If I come off the quetiapine, it will need to be replaced and I'd have to see a psychiatrist for that and I don't have €200 lying around to see one. I just find it strange that if I take a lower dose, it doesn't happen. Did you come off the quetiapine?

[Moonlight Princess]

Just checked and it does say that quetiapine and blood pressure medication might interact so that could be what's happening. Have you ever been on a 200mg dose and was that dose helpful to you?

[Ktulu]

Hi, yes I've been on 200mg before, but when I was titrating between doses. I've been on various doses between 50mg and 800mg. I don't think 200mg will actually do anything for me in respect of mood stabilisation, it really needs to be up around 400mg for that. The dose was increased from 100mg to 400mg last October during a brief hypomanic episode. I've been on it so long now, I cannot sleep without it, I will be awake for days literally if I don't take it. There definitely seems to be some connection between the dose increase and the new BP tablet because I never had any kind of a problem like this before. I am having bloods done on Tuesday to check my renal function and lithium level as there is a definite interaction between the ACE inhibitor and lithium and the GP was concerned it would increase my Li level and effect my renal function, but he said most of the newer BP medications have this problem and its a matter of taking the risk and monitoring it closely.

[Epicene]

It sounds like the quetiapine is helpful for you, so I wonder if it's worth exploring the sleep apnoea independently in the first instance? You can go to sleep clinics to get a better idea of what is happening. Personally I get on great with quetiapine so haven't come off it (even though it's given me diabetes). I just try to sleep on my side in the recovery position so my airway isn't at all blocked.

[MissAnonymous]

Its fairly easy to have sleep apnoea investigated and can be done at home with a series of straps to your chest, pulse oximeter and instruments measuring breathing.

Your GP should be able to get this organised, risk factors are being overweight or carrying weight around your neck. Also medications that depress the CNS will make sleep apnoea worse so I presume it could exacerbate a mild case. And cases do vary, hugely.

My dad has sleep apnoea and finds sleeping sitting up reduces the gravitational pressure on his neck and chest. Obviously alcohol, codiene, benzos (the latter two he is prescibed might I add, he needs to be very careful with because they will increase episodes). Quetiapine is not so much a CNS depressant although it can become a CNS depressant when mixed with other sedating drugs, sedation is a side effect of quetiapine itself too.

[Ktulu]

Oh gosh, so sorry to hear it's given you diabetes. But it really is such a useful drug. I popped into the pharmacy this evening to get a script for my mother and mentioned it to the pharmacist. He went and got my GP who came out and listened to my heart and lungs. He said my heart was pounding and to stop the ACE inhibitor straight away and he will come and see me on Tuesday during my nurse appointment. He and the pharmacist agreed it was unusual but possible. I feel relieved now because I kept trying to tell myself it was just anxiety but the doctor and pharmacist agreed it could be the combination of drugs I'm on as it has only happened since the changes were made.

[MissAnonymous]

I'm really glad you spoke to the pharmacist and a doctor. Hopefully the problems will resolve and if you still need the ACE inhibitor they can look at another type of BP therapy.

[Ktulu]

Yes, I'm very glad I said it now. Normally the shop is milling but I was the only one there so took the opportunity. He scared me a little when he insisted I had to see a doctor in the morning but I'm working all weekend, it was a stroke of luck that my GP was still in the building at 7pm on a Friday.

I do carry weight around my neck/chin. I always sleep on my front or side with three pillows but I've never had this problem before. Or should I say, I've never noticed it before so it is quite possible that the drugs have exacerbated a mild problem as you say. It seems that ACE inhibitors can cause bronchoconstriction which I didn't realise. I'll be happier coming off it anyway due to the potential interaction with lithium, I'm already on a high dose and can't afford it to reach toxic levels. My GP said we'll look at alternatives on Tuesday.

[Ktulu]

I just thought I'd update this in case anyone else had similar troubles. It turns out it was nothing to do with the Seroquel at all, thankfully. The bp medication I was on (an ace inhibitor) can commonly cause a cough, which I didn't have. But by the same mechanism can more rarely cause bronchospam. This is what my gp thinks happened to me as it was getting progressively worse. I'm on a different class of bp medication now and am back on my regular dose of seroquel with no problems �� I'm so relieved as seroquel is one the drugs that has made a massive difference in my life.

[Arienette]

Oh yay I'm glad you got to the bottom of it. X

[Epicene]

Thanks for updating this, I was curious about this. Great to hear it's not the Seroquel!