Sleep apnea following withdrawal of amitriptyline

A 41-year-old man developed sleep apnea following abrupt cessation of amitriptyline. Cessation of antidepressants may result in excessive release of acetylcholine, which increases REM sleep. This in turn increases disordered breathing time and decreases nocturnal oxygenation. Sleep apnea did not recur when amitriptyline was reinstated and later gradually discontinued.