With vs Without protriptyline

[Beej]

So I decided to see what might happen if I skipped the protriptyline last night.

Here

Just one pair of nights, but looking at the 2 suggests that the protriptyline is helping some.

With it
Hypopnea: 2
Obstructive: 4
RERA: 6

Without it for 1 night
Clear: 6
Hypopnea: 5
Obstructive: 11
RERA: 11

Note that the diagnostic sleep study was done after 2 weeks without the protriptyline and the CPAP titration was done after 2 weeks back on it. (here)

[robysue]

Beej,

What was the protriptyline prescribed for?

If it helps you establish continuous sleep faster and helps you maintain sleep by reducing the number of spontaneous arousals, that could explain the difference in the data.

Of course, it could also be that you just happen to be comparing a "good" night that would have been "good" regardless of whether you took the protriptyline to a "bad" night that would have been "bad" regardless of whether you took the protriptyline or not.

[Sleeprider]

I don't understand the action of this medication well enough to comment on its possible effect on CPAP therapy or apnea in general, however I would caution against any abrupt discontinuation of any medication of this type, or in drawing conclusions of the effect of a one night abstention.

[Beej]

What was the protriptyline prescribed for?...

It was originally prescribed back around 1994 of a mixed central apnea. From what I've read, it reduces the amount of REM sleep which is when many apneas happen.

...I would caution against any abrupt discontinuation of any medication of this type, or in drawing conclusions of the effect of a one night abstention.

I went off it for 2 weeks pre-diagnostic sleep study with no problems other than getting more and more daytime hypersomnolence.

I'm on a pretty low dose for these reasons:
1) it does some of the same things as the paroxetine does for me, but I wasn't able to take just the protriptyline due to side effects.
2) the paroxetine potentiates the protriptyline resulting in anywhere from 2-5 times the expected blood level based on dose.
3) I am a slow metabolizer of the enzymes which breaks both of these down (CYP 450 2D6 for those who want to look it up). I had to cut back both the paroxetine and the protriptyline to 5 mg and 1.25ish mg (quartered tablet because of the potentiation) in order to avoid hallucinations and seizures. I'd never had an hallucination before ... and it was a boring one at that.

For those who'd like a bit more info on CYP 450 drug interactions, see this.