Am I really negative for UARS? Taking Trazodone

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Morganite
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Am I really negative for UARS? Taking Trazodone

Post by Morganite » Mon Jan 26, 2015 3:48 pm

My sleep doctor called today and said I only have 3 RERA's per hour. I was taking trazodone plus zinc picolinate which I find very sedating for some reason when I took the sleep test. My last sleep test I was literally awake for all but 45 minutes of the night, so I took extra stuff to stay asleep. I have taken trazodone for almost 20 years because otherwise I would wake completely up about every 20 minutes. If I were not to take it, my sleep would be so poor, I think my life would unravel.

When I do wake up, I am often hot with my heart beating hard. I wake up in REM generally. I wake up in response to any light, noise, smells, or movement.

Consistent with UARS, I am young, thin, and female with a small neck, small set back jaw, narrow high palate. I have trouble breathing through my nose. I wake up clenching my teeth. I am cold almost all the time with very low blood pressure. I'm usually very tired. I can hardly remember anything. If something happened more than a few days ago, I can't remember it. It's just gone. My husband pays the bills, and makes sure I turn off the oven and lock the doors.

Doc says every aspect of my report looks normal. I haven't seen the results in person. The sleep test involved a cannula up my nose and elastic around my rib cage.

Any thoughts? Thanks so much.

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Julie
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Re: Am I really negative for UARS? Taking Trazodone

Post by Julie » Mon Jan 26, 2015 3:55 pm

Hi - it's very unclear whether you scored any apneas on the test... just 'not' having any (or 3) RERA's does not tell us much.

And if I were you I'd be breaking down the doors of other MD's to do something about the trazadone... either get off it, experiment with the dosage, or replace it with something else better thought out (things have changed very much in 20 yrs).

But without even knowing if you were diagnosed with apnea or anything else it's hard to comment. Yes, you describe your physical attributes as being typical of some apnea patients, but that alone is not enough (again) to diagnose anything, UARS or apnea or RERA.

Why you haven't even obtained (by your legal right) a copy of the full sleep study (vs summary) is a question too, but out of curiosity, have you been tested for any other causes of tiredness, sleepiness, fogginess, etc. like thyroid problems, blood issues, neurological things?

If you can post a copy of your study here (even just the summary) maybe someone could comment, but as things are now, there's nothing to say except that the lengthy trazadone usage is not a good idea, with or without apnea.

Morganite
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Re: Am I really negative for UARS? Taking Trazodone

Post by Morganite » Mon Jan 26, 2015 4:39 pm

With a little luck, I will receive a full report in the mail tomorrow and I will post it. He said I had a "few" apneas total during the night and 3 rera's per hour. Normal percentages of REM, etc. Sleep tech let it slip that I had a lot of REM. I guess the report will reveal all.

What are alternatives to trazodone? I hate the hypnotics. Remeron doesn't work. Zyprexa makes for beautiful sleep, but leaves me very depressed. Hate benzo's. Hate melatonin. Hate seroquel. Hate hydroxyzine.

I try to keep abreast, but I haven't seen anything in a while that seemed like a possibility.

I have been tested for everything imaginable. Seen doctors all over the country. I am extremely pro-active and have thus far been left without answers. I do expect to be formally diagnosed with a hereditary connective tissue disorder soon, which is itself linked to sleep-disordered breathing.

musculus
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Re: Am I really negative for UARS? Taking Trazodone

Post by musculus » Mon Jan 26, 2015 4:43 pm

I would bet you have UARS based on your description.

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Morganite
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Re: Am I really negative for UARS? Taking Trazodone

Post by Morganite » Mon Jan 26, 2015 4:57 pm

Add to my symptoms list night time urination and IBS.

This is what I found about trazodone. It decreases your sensitivity to waking up in response to sleep disordered breathing. One question is- how do I do a sleep test where I am able to go back to sleep after waking up when I just stay awake if I'm undermedicated and perhaps don't let my UARS show its true colors if I take the only thing that keeps me even remotely asleep at night. Maybe take slightly less trazodone than usual. It's quite a delicate balance.

Sleep. 2014 Apr 1;37(4):811-9. doi: 10.5665/sleep.3596.
Trazodone increases the respiratory arousal threshold in patients with obstructive sleep apnea and a low arousal threshold.
Eckert DJ1, Malhotra A2, Wellman A3, White DP3.
Author information
Abstract
STUDY OBJECTIVES:
The effect of common sedatives on upper airway physiology and breathing during sleep in obstructive sleep apnea (OSA) has been minimally studied. Conceptually, certain sedatives may worsen OSA in some patients. However, sleep and breathing could improve with certain sedatives in patients with OSA with a low respiratory arousal threshold. This study aimed to test the hypothesis that trazodone increases the respiratory arousal threshold in patients with OSA and a low arousal threshold. Secondary aims were to examine the effects of trazodone on upper airway dilator muscle activity, upper airway collapsibility, and breathing during sleep.
DESIGN:
Patients were studied on 4 separate nights according to a within-subjects cross-over design.
SETTING:
Sleep physiology laboratory.
PATIENTS:
Seven patients with OSA and a low respiratory arousal threshold.
INTERVENTIONS:
In-laboratory polysomnograms were obtained at baseline and after 100 mg of trazodone was administered, followed by detailed overnight physiology experiments under the same conditions. During physiology studies, continuous positive airway pressure was transiently lowered to measure arousal threshold (negative epiglottic pressure prior to arousal), dilator muscle activity (genioglossus and tensor palatini), and upper airway collapsibility (Pcrit).
MEASUREMENTS AND RESULTS:
Trazodone increased the respiratory arousal threshold by 32 ± 6% (-11.5 ± 1.4 versus -15.3 ± 2.2 cmH2O, P < 0.01) but did not alter the apnea-hypopnea index (39 ± 12 versus 39 ± 11 events/h sleep, P = 0.94). Dilator muscle activity and Pcrit also did not systematically change with trazodone.
CONCLUSIONS:
Trazodone increases the respiratory arousal threshold in patients with obstructive sleep apnea and a low arousal threshold without major impairment in dilator muscle activity or upper airway collapsibility. However, the magnitude of change in arousal threshold was insufficient to overcome the compromised upper airway anatomy in these patients.
KEYWORDS:
Arousal; lung; muscles; respiratory physiology; sedative; sleep-disordered breathing; upper airway

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Minky
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Re: Am I really negative for UARS? Taking Trazodone

Post by Minky » Mon Jan 26, 2015 5:20 pm

Hi Morganite,

I was diagnosed with UARS in November after years of exhaustion. I have all of the classic symptoms-BP is 90/50, small neck, Raynauds to the point that my nail beds are always dark purple, migraines, etc.

I also was not asleep for very long during my sleep study and did not have too many RERAs. The one thing I had tons of were spontaneous arousals. From what I understand, and I could be wrong, is that people with UARS have such hypersensitive nervous system that we wake up long before the sleep disordered breathing can turn into a hypopnea.

My sleep doctor and I decided that I would try APAP for two weeks to see if it helped. The drawback is that most insurance won't pay for APAP if you don't have an AHI of 5 or more. Mine untreated was 1.1 and treated is between 0.0 and 0.2. I'm sure the sleep doc would have been willing to appeal to the insurance company, but I could not wait any longer to get my life back. I got the prescription, ordered from CPAP.com and have used it every night since 12/9. Recovery is slow, but it was the best money I ever spent and will use APAP for the rest of my life. In my case, and in many cases, UARS causes chronic insomnia. I'm no longer awake for hours every night and fall asleep within a half hour. Life is better.

If you have the option of trying an APAP with the possibility of buying I would really recommend it.

Morganite
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Re: Am I really negative for UARS? Taking Trazodone

Post by Morganite » Mon Jan 26, 2015 5:46 pm

I wanted to draw everyone's attention to this device:

https://dnaappliance.com/


It's like a permanent fix for the bone structure that causes sleep disordered breathing. FDA approved for OSA. It's the one I want.

And yes on the Raynaud's. No migraines though. Also BP 85/55. I'm a rip roaring ball of energy.

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palerider
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Re: Am I really negative for UARS? Taking Trazodone

Post by palerider » Mon Jan 26, 2015 5:52 pm

Morganite wrote:I wanted to draw everyone's attention to this device:
the first thing I see from the comparison pics is that IT FIXES YOUR HAIR!!! amazing.

(after looking at more pics, that seems to be the main thing, though it shuffles teeth around too, I'm guessing.

it removed braces in one pic.

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tan
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Re: Am I really negative for UARS? Taking Trazodone

Post by tan » Mon Jan 26, 2015 6:09 pm

Morganite wrote: What are alternatives to trazodone? I hate the hypnotics. Remeron doesn't work. Zyprexa makes for beautiful sleep, but leaves me very depressed. Hate benzo's. Hate melatonin. Hate seroquel. Hate hydroxyzine.

I try to keep abreast, but I haven't seen anything in a while that seemed like a possibility.

I have been tested for everything imaginable. Seen doctors all over the country. I am extremely pro-active and have thus far been left without answers. I do expect to be formally diagnosed with a hereditary connective tissue disorder soon, which is itself linked to sleep-disordered breathing.
Could it be that your symptoms are worse because of the meds? It seems like you have tried them all. With a bad sleep, I heard and read that the first order of business is get rid of pills. How is your sleep hygiene? Do you get up at the same every morning and spend in your bed no more than, well, 7 hours?

Morganite
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Re: Am I really negative for UARS? Taking Trazodone

Post by Morganite » Mon Jan 26, 2015 6:35 pm

I think my sleep problems are well beyond anything sleep hygeine could touch. It's kind of nuts. Before trazodone, I could not fall asleep until 3am. I did not become sleepy, I just became to ill to be awake any longer. I had the distinct sensation that my body simply would not take the sleep that I needed. Maddening. I would wake very frequently and stay awake. My sleep hygeine for the last twenty years has included white noise, ear plugs, sleep mask, and never sleeping in the same bed as anyone else. I think the trazodone actually keeps me together, suppresses a lot of the problem. I think I would be adrift without it. Love my white noise. Love my trazodone.

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Julie
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Re: Am I really negative for UARS? Taking Trazodone

Post by Julie » Mon Jan 26, 2015 6:44 pm

I honestly don't think you're able now to sort out what's what, having been on Traz for 20 yrs and until you get off it, won't know. You may have needed proper treatment for insomnia (only) when you started, but got caught up in the med cycle and may or may not have ended up with UARS or not, or something else, or not. You may still only need help with insomnia, sans meds (waiting long enough for their effect to be gone) but you'll never know until you try. For the record I'm not some no-meds-no-matter-what nut, but someone who worked for neurologists and other specialists x 30 yrs and I think you've gotten into a complex cycle that may take some time to get out of... your system's so involved with Traz by now it may be hard to get back to whatever normal might be (or might have been) for you at this time.

brendastarr
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Re: Am I really negative for UARS? Taking Trazodone

Post by brendastarr » Mon Jan 26, 2015 7:07 pm

Morganite wrote:I wanted to draw everyone's attention to this device:

https://dnaappliance.com/


It's like a permanent fix for the bone structure that causes sleep disordered breathing. FDA approved for OSA. It's the one I want.

And yes on the Raynaud's. No migraines though. Also BP 85/55. I'm a rip roaring ball of energy.
Smart woman! I'm undergoing expansion now, with something similar.

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Morganite
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Re: Am I really negative for UARS? Taking Trazodone

Post by Morganite » Mon Jan 26, 2015 7:11 pm

Can you post more about the negative consequences of being on trazodone? Also, more information about what happens for the good when people get off sleep medications? Are there any studies? I am certainly habituated to trazodone, but I could get off of it slowly, I expect. Are there any studies you could post about permanent changes from being on trazodone this long? Thanks

Also, when I think about it, I don't know why my sleep or overall well-being would improve necessarily by being off trazodone. I have had the teeth grinding, restless sleep, fatigue, and REM awakening since I was a small child, well before trazodone.

Morganite
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Re: Am I really negative for UARS? Taking Trazodone

Post by Morganite » Mon Jan 26, 2015 7:12 pm

BrendaStarr- Which appliance do you use?

Morganite
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Re: Am I really negative for UARS? Taking Trazodone

Post by Morganite » Mon Jan 26, 2015 7:12 pm

I've also been cold with low blood pressure since I was a child.