Sleep Apnea & Keppra
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Q:  Sleep Apnea & Keppra

I have been taking Lithobid 1200mg all at night and Seroquel 12.5mg (all I can tolerate) for the past two years. I was diagnosed with Sleep Apnea one year ago and started CPAP therapy. I am getting to sleep within 45 minutes but having trouble sleeping all night. Do you think adding Keppra to the mix would bring me any benefits. The lack of sleep is causing mania swings and the swings induce insomnia ! Any suggestions would be deeply appreciated.

Dear George -- 
Hmm, is there some reason why we're looking at agents with little or no evidence for long-term bipolar effectiveness (due primarily perhaps to their young age, i.e. Seroquel and Keppra) as opposed to the more
well-established options such as Depakote, carbamazepine, and some would put risperidone on that list even ahead of Seroquel because it's been around a good deal longer so we know more what to expect with it -- ?  Or, since sleep apnea is often associated with being overweight, perhaps you'd need to look at options clearly not associated with weight gain, e.g. the carbamazepine again, or on this list, lamotrigine; or even fish oil, some would add (and certainly a program of physical activity, which should be in the mix regardless; here's my not-the-usual rap on that).  

You get the picture:  we have almost no data on Keppra yet.  I like to start with the options for which we have evidence; or at least a lot of experience; or barring that, evidence for low/no risk (thus the fish oil) before moving on to the newest stuff.  (I just checked for any new data on Keppra; no, only one open trialGrunze (no control group; lots of things look good initially when studied this way) and some case reports. 

Dr. Phelps

Published November, 2004


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