Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

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EricinNC
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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by EricinNC » Sat Mar 19, 2011 7:33 pm

mstevens wrote:
Mr Bill wrote:I asked my pharmacist what he would suggest as an antihistamine ... He said that anything that would make me sleepy would also tend to suppress respiratory drive.
This just shows why one shouldn't get medical advice from pharmacists.

Some sedating drugs can suppress respiration. Some others do not.
???????????????????????????????????


Sounds kosher to me. I agree with the pharmacist and its common knowledge that anti-histamines tend to be sedating, some more than others. Benadryl definitely relaxes the airway and the muscles. Its used in parkinsons patients off label to relax tightened muscles from dopamine depletion, ditto for psychiatric patients taking anti-psychotics who experience EPS. Get EPS from neuroleptics you know what your shrink will tell you? Take OTC benadryl.

The pharmacist is correct. Not only does it suppress respiration, anti-histamines relax the muscles in the airway.



Eric

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by mstevens » Sat Mar 19, 2011 8:57 pm

EricinNC wrote:The pharmacist is correct.
No. Not all sedating drugs suppress respiration. The fact that, in extremely high doses, diphenhydramine can suppress respiration is correct. The general statement that follows that one is not.

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by mstevens » Sat Mar 19, 2011 9:14 pm

EricinNC wrote:
NightMonkey wrote:You are tripping over the terminology. The difference between dependence and addiction is huge.
you dont know what you are talking about. Take 2 to 4 mg klonopin for ten years and see if you do not become physically addicted to it. You will.
NightMonkey does know what NightMonkey is talking about. You are, in fact, tripping over terminology and there is, in fact, a huge difference between dependence and addiction. Addiction is a set of behaviors. Dependence is a physiological phenomenon. They are not the same and don't necessarily overlap at all.

Here's an example: I (and you) are highly dependent upon a number of substances - glucose, oxygen, water, and so on. Let's pick one near and dear to the hearts of most of us: oxygen. I am completely dependent upon it. If you cut off my supply, I become anxious and cranky quite rapidly then in short order I develop severe symptoms due to not having it. If my supply is not restored, it'll actually kill me. At some point in the deprivation process, I'll do just about anything to get more. I'm not addicted to oxygen, nor is there a case in the world literature of anyone becoming addicted to it. If you prefer a prescription example, think injected insulin.

Here's a different example: Joe uses cocaine. He does not experience any physical symptoms at all when he stops it, no matter how abruptly or for how long. Therefore, he is not physically dependent upon cocaine. He does spend a great deal of time thinking about cocaine and scheming to get it. He has embezzled money from work and pawned his girlfriend's TV to pay for it. He lives with his girlfriend because he lost his house after spending all his mortgage money on cocaine. He's not sinus damage and recently had a heart attack, both of which were blamed on cocaine, but he continues to use. Joe is addicted to cocaine, but is not physically dependent upon it.

If you're using a medication appropriately as prescribed and are not experiencing any harm from using it, you are not addicted to it no matter how physically dependent upon it you may be.

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by chrisp » Sat Mar 19, 2011 9:45 pm

I have been taking clonazepan for several years. I helps me sleep and thats all. I have noticed no problems and no unusual events in my sleep data. Its the only way I can get descent sleep. Tried everything else. No increase in pressure, headachs, other aches. Just sleep. For Me that is.
As always YMMV.


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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by BrianinTN » Sat Mar 19, 2011 11:20 pm

Back to the topic at hand: it sounds like despite some warnings from medical practitioners to the contrary, virtually no one on these boards has witnessed an empirical, day-driven, observed link between benzodiazepines and sleep apnea, save one account. I'd love to hear from others, because so far the pattern (from an admittedly very small sample size) is that the link between the two is either not universal or often overstated.

Eric: I would love to see a set of waveforms or other data snapshots -- one with and one without the klonopin. Some data specifically on the pressure difference requirements in your case would be helpful.

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by jonquiljo » Sat Mar 19, 2011 11:38 pm

mstevens wrote: If you're using a medication appropriately as prescribed and are not experiencing any harm from using it, you are not addicted to it no matter how physically dependent upon it you may be.

Well, yeah! No kidding. The bottom line is what happens if you stop taking the stuff? In this case, you will experience severe withdrawal symptoms. Yes, I have actually known benzodiazepine addicts in my life - people who will down a whole bottle of Xanax if they thought they could get away with it. Most people taking these meds are just physiologically dependent. This is all just semantics as we are talking a big problem should you not want to take these drugs anymore.

Many Dr's love to prescribe Klonopin because they are taught that it's not "abusable." Basically it can't really make you "high" - whereas certain benzodiazepines like Xanax can give you a sort of "high." The sad part is these Dr's really think they are doing you a favor by giving you something that is not easily abused (i.e. - Klonopin) - but you end up dependent regardless. Klonopin is actually worse because larger equivalent doses are given. A 0.5 mg dose of Klonopin is roughly equivalent to 10mg of Valium. So, often people are given these whopping 2mg doses to take. That's like taking 40mg of Valium or 2mg Xanax. Or they are prescribed even more!

Then the Dr's get really stupid. Since they are taught that Klonopin is "not addictive" - they just take you off the stuff. They say, "just stop taking it" or "taper off over the course of a week". Well, as lots of us have found out the hard way - this is not very easy to do (at 2-4mg of Klonopin, try months!). It can make you totally sick and crazy! In fact, it is commonly said that getting off of benzodiazepines is a lot harder than getting off of opiates. So the moral of the story here is don't listen to these Dr's at all and take the stuff to begin with - unless you find out what you will be dealing with later. I listened to a Dr like this 20 years ago, and it took me a very very long time to deal with the problem. I will never trust a Dr. again without first checking out the issues with a medicine beforehand.

I'm not saying that these drugs can't be helpful, but they are going to make you physically dependent irregardless. You will have to taper off slowly - over months or even years. Just make sure if a Dr. gives you some for a while, and that he or she will continue to prescribe them until you want and can get off them. If not, you're talking about a whole lot more than a bad weekend.

Another silly thing about Klonopin is that it has such a long half life that if you take it at night to sleep, you will still be tired the next day. If you do this every night - then you will be tired every day. There are a lot of people running around tired every day not realizing it is because of all the Klonopin they took to get to sleep. Now Xanax is the total opposite. You get sedated after taking it, but it has a relatively short half life. When you become physically dependent - you start to go into withdrawal about 12 hours after taking it at night. So you are in withdrawal by noon the next day. You limp along in a semi -panic attack until evening and take it again - then you feel calmer and can sleep. And so on.

I really hate scaring people who take these meds. But I have seen way too many friends (myself included) told by ignorant Dr.'s that they are not a problem. Too many Dr's give them to you for 6 months and then tell you to taper off over the weekend. EricinNC is totally correct. I have never heard of any medical help (short-term detox) that has worked for these drugs. All I have ever heard of are slow tapers which require the cooperation of a Dr to slowly wean you off the stuff.

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by EricinNC » Sat Mar 19, 2011 11:55 pm

mstevens wrote:
EricinNC wrote:
NightMonkey wrote:You are tripping over the terminology. The difference between dependence and addiction is huge.
you dont know what you are talking about. Take 2 to 4 mg klonopin for ten years and see if you do not become physically addicted to it. You will.
NightMonkey does know what NightMonkey is talking about. You are, in fact, tripping over terminology and there is, in fact, a huge difference between dependence and addiction. Addiction is a set of behaviors. Dependence is a physiological phenomenon. They are not the same and don't necessarily overlap at all.

Here's an example: I (and you) are highly dependent upon a number of substances - glucose, oxygen, water, and so on. Let's pick one near and dear to the hearts of most of us: oxygen. I am completely dependent upon it. If you cut off my supply, I become anxious and cranky quite rapidly then in short order I develop severe symptoms due to not having it. If my supply is not restored, it'll actually kill me. At some point in the deprivation process, I'll do just about anything to get more. I'm not addicted to oxygen, nor is there a case in the world literature of anyone becoming addicted to it. If you prefer a prescription example, think injected insulin.

Here's a different example: Joe uses cocaine. He does not experience any physical symptoms at all when he stops it, no matter how abruptly or for how long. Therefore, he is not physically dependent upon cocaine. He does spend a great deal of time thinking about cocaine and scheming to get it. He has embezzled money from work and pawned his girlfriend's TV to pay for it. He lives with his girlfriend because he lost his house after spending all his mortgage money on cocaine. He's not sinus damage and recently had a heart attack, both of which were blamed on cocaine, but he continues to use. Joe is addicted to cocaine, but is not physically dependent upon it.

If you're using a medication appropriately as prescribed and are not experiencing any harm from using it, you are not addicted to it no matter how physically dependent upon it you may be.

How did you get a medical license? It is well established in medical literature that taking benzos longterm leads to physical addiction, dependence, whatever you wish to call it. There are many physicians who will not prescribe benzos for more than a month or two, for fear of getting the patient physically addicted/dependent/whatever. In fact, until a few years ago when there were all those class action lawsuits about atypical anti-psychotics causing metabolic syndrome and type II diabetes, some psychiatrists were prescribing low dose atypical APs instead of benzos. As atypical APs are not controlled substances and have no physical addiction/dependence potential. And with MDs being the way they are, some of them would rather risk their patient's health with atypical APs than prescribe benzos longterm.

Again, just like some psychiatrists refuse to prescribe MAOI antidepressants to patients no matter how severe their depression is...there are also some who refuse to prescribe benzos longterm. I speak from experience and know what I am talking about.

I cannot believe this conversation is even occurring. I know it is the Internet and such and Im skeptical you are even a real MD after reading your post.

If benzos do not have significant physical addiction/dependence potential, then WHY are these drugs controlled substances? HUH? Why are they controlled by the DEA? HUH? There is a reason and the reason is these drugs are drugs of dependence/physical addiction. Denying this is a sign you have a drug problem.

I can admit I have a klonopin problem, some cant. I can go off my antidepressant and dont experience the "withdrawal" I experience by going off even small amounts of klonopin. Antidepressants are not controlled substances.

This is the most stupid conversation Ive had on the Internet in a long, long time.

Eric

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by EricinNC » Sun Mar 20, 2011 12:01 am

BrianinTN wrote:Back to the topic at hand: it sounds like despite some warnings from medical practitioners to the contrary, virtually no one on these boards has witnessed an empirical, day-driven, observed link between benzodiazepines and sleep apnea, save one account. I'd love to hear from others, because so far the pattern (from an admittedly very small sample size) is that the link between the two is either not universal or often overstated.

Eric: I would love to see a set of waveforms or other data snapshots -- one with and one without the klonopin. Some data specifically on the pressure difference requirements in your case would be helpful.

Ive looked at my Rescan reports from days when I take my standard 4 mg klonopin and other days when I take a double dose of klonopin when I am jacked up real bad. On days when I take 8 mg klonopin, my pressures nearly bottom out. That is why I leave my APAP wide open on the upper pressure, all the way to 20.

Anybody who tells me that sedating medications dont worsen OSA, they need to STFU and go check themselves into the nuthouse. Its dangerous telling people that taking benzos will not relax their airway more, particularly people at set pressures. I had a sleep doc tell me flat to my face "its dangerous taking extra klonopin." Duh. Sometimes I do it anyway. I have an APAP that I leave wide open all the way to 20. The highest its ever been is a little over 19 and thats ONLY been when I took extra klonopin.

Again, the info peddled here by a few of the "naysayers" about benzos here is extremely dangerous and ignorant. And ridiculous as well. All the official OSA literature advises patients to avoid sedating medications particularly at night or late afternoon. That includes benzos, barbituates, anti-histamines and booze.

Eric

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by EricinNC » Sun Mar 20, 2011 12:06 am

jonquiljo wrote:
mstevens wrote: If you're using a medication appropriately as prescribed and are not experiencing any harm from using it, you are not addicted to it no matter how physically dependent upon it you may be.

Well, yeah! No kidding. The bottom line is what happens if you stop taking the stuff? In this case, you will experience severe withdrawal symptoms. Yes, I have actually known benzodiazepine addicts in my life - people who will down a whole bottle of Xanax if they thought they could get away with it. Most people taking these meds are just physiologically dependent. This is all just semantics as we are talking a big problem should you not want to take these drugs anymore.

Many Dr's love to prescribe Klonopin because they are taught that it's not "abusable." Basically it can't really make you "high" - whereas certain benzodiazepines like Xanax can give you a sort of "high." The sad part is these Dr's really think they are doing you a favor by giving you something that is not easily abused (i.e. - Klonopin) - but you end up dependent regardless. Klonopin is actually worse because larger equivalent doses are given. A 0.5 mg dose of Klonopin is roughly equivalent to 10mg of Valium. So, often people are given these whopping 2mg doses to take. That's like taking 40mg of Valium or 2mg Xanax. Or they are prescribed even more!

Then the Dr's get really stupid. Since they are taught that Klonopin is "not addictive" - they just take you off the stuff. They say, "just stop taking it" or "taper off over the course of a week". Well, as lots of us have found out the hard way - this is not very easy to do (at 2-4mg of Klonopin, try months!). It can make you totally sick and crazy! In fact, it is commonly said that getting off of benzodiazepines is a lot harder than getting off of opiates. So the moral of the story here is don't listen to these Dr's at all and take the stuff to begin with - unless you find out what you will be dealing with later. I listened to a Dr like this 20 years ago, and it took me a very very long time to deal with the problem. I will never trust a Dr. again without first checking out the issues with a medicine beforehand.

I'm not saying that these drugs can't be helpful, but they are going to make you physically dependent irregardless. You will have to taper off slowly - over months or even years. Just make sure if a Dr. gives you some for a while, and that he or she will continue to prescribe them until you want and can get off them. If not, you're talking about a whole lot more than a bad weekend.

Another silly thing about Klonopin is that it has such a long half life that if you take it at night to sleep, you will still be tired the next day. If you do this every night - then you will be tired every day. There are a lot of people running around tired every day not realizing it is because of all the Klonopin they took to get to sleep. Now Xanax is the total opposite. You get sedated after taking it, but it has a relatively short half life. When you become physically dependent - you start to go into withdrawal about 12 hours after taking it at night. So you are in withdrawal by noon the next day. You limp along in a semi -panic attack until evening and take it again - then you feel calmer and can sleep. And so on.

I really hate scaring people who take these meds. But I have seen way too many friends (myself included) told by ignorant Dr.'s that they are not a problem. Too many Dr's give them to you for 6 months and then tell you to taper off over the weekend. EricinNC is totally correct. I have never heard of any medical help (short-term detox) that has worked for these drugs. All I have ever heard of are slow tapers which require the cooperation of a Dr to slowly wean you off the stuff.
This doc probably has a few patients he got on klonopin or some other controlled substance and he is rationalizing it to ease his mind. That is my suspicion. You are 100% correct in the claim that there are benzo addicts and the addiction is entirely legally prescribed. Its not rocket science. You take any controlled substance long enough, especially at higher dosages and you are going to get addicted/physically dependent. One of the few voices of reason in this particular string of posts. The most stupid string of posts Ive read on the Internet in a long long time. Its posts like this that drove me away from Internet medical forums for a long time. Asinine stupidity by nameless faceless idiots. And dangerous advice peddled by "Internet doktors."


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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by DavidCarolina » Sun Mar 20, 2011 12:37 am

I dunno. Klonapin more or less saved my life, because when the full effect of Apnea/Snoring took
effect in my central nervous system, I felt out of breath, agitated, and exhausted all the time during the day.

I was on up to 3 or more MG per day total.

Since the pap, ive cut this down to 1-2 MG.

I think my central nervous system is still "recovering", whether thats in the hypothalmus, or
the blood gas "feeling" in there, or whatever it is.

I've had all kinds of nuerological tests, even at the Mayo Clinic, and they cant recommend anything better than
Klonapin........other than maybe xanex, which I didnt like.

They try to get you on something milder such as Norpramin....which can help some.

But to answer your question, Klonapin never made me feel out of breath, in fact, just the opposite.

And as far as "long term" implications of using the drug, Im not sure---my wifes best friend has MS, and
she's been using the drug for 20 years in various doses.

I think each of our cases, and the level of damage we did is unique, although I agree that its best
to try to use as little medication as possible in our journey.

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by BrianinTN » Sun Mar 20, 2011 12:42 am

EricinNC wrote: Again, the info peddled here by a few of the "naysayers" about benzos here is extremely dangerous and ignorant. And ridiculous as well. All the official OSA literature advises patients to avoid sedating medications particularly at night or late afternoon. That includes benzos, barbituates, anti-histamines and booze.

Eric
The reason I asked the question and started the thread is that I'm not entirely convinced this is the case. There are a couple issues at hand. First is the dosage. It sounds like you are taking a *LOT* of the stuff. In my OP, you'll see that I referenced a dose of 0.5mg. Pretty big difference. Second, not everyone reacts the same way. At least a couple people in this thread seem to have had little to no OSA events as a result of mild klonopin use.

My major question remains -- what is the effect of occasional and very mild use of a benzo on a sleep study, and to what extent would it affect results *especially* in a titration study? So far I haven't seen anyone suggesting this is a big deal.

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by DavidCarolina » Sun Mar 20, 2011 12:51 am

One thing is certain: everybody's body chemistry is different, and their reaction to various doses for various reasons
is totally unique.

Histamine, from what I understand, causes extreme agitation in certain people, and so an "anti" histamine that
calms your CNS makes sense.

But we all agree that we dont want to be on a dangerous level of dose, and that our goal is to get off meds to the extent that we all can as we make progress.

But I dont think Im dependant on Klonapin, because certain days go by when I just dont need it, and others when i cant live without it in order to feel remotely normal.

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by jonquiljo » Sun Mar 20, 2011 3:09 am

DavidCarolina wrote: And as far as "long term" implications of using the drug, Im not sure---my wifes best friend has MS, and
she's been using the drug for 20 years in various doses.

I'm not sure benzodiazepines are bad medicines - just be aware that if you've taken them for a while - you just can't stop taking them.

EricinNC: It's not bad Internet medicine - it's bad medicine - period. I look at the Internet as a place where people can warn other's of potential problems they may not know of. Your family Dr is least likely to warn you.

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by EricinNC » Sun Mar 20, 2011 9:59 am

jonquiljo wrote:
DavidCarolina wrote: And as far as "long term" implications of using the drug, Im not sure---my wifes best friend has MS, and
she's been using the drug for 20 years in various doses.

I'm not sure benzodiazepines are bad medicines - just be aware that if you've taken them for a while - you just can't stop taking them.

EricinNC: It's not bad Internet medicine - it's bad medicine - period. I look at the Internet as a place where people can warn other's of potential problems they may not know of. Your family Dr is least likely to warn you.

Agreed totally.

Eric

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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Post by mstevens » Sun Mar 20, 2011 10:36 am

EricinNC wrote:It is well established in medical literature that taking benzos longterm leads to physical addiction, dependence, whatever you wish to call it.
What I "wish to call it" depends on what it is, since "physical addiction" does not exist and since addiction and dependence are different things.

EricinNC, I don't think anybody is claiming that clonazepam can't be both addictive and prone to causing physical dependence. It most certainly can. In fact, it can do one or the other of those things, neither, or both. It depends upon the person and the situation.

Where you are getting tripped up is in terminology, which in medicine is pretty important. Dependence and addiction are different things. Yes, I understand that to many people the terms are interchangeable since to them it makes no difference. To someone prescribing it makes a huge difference as it does to someone who needs to assess whether someone is addicted. It is a daily necessity for me to do the latter - is Suzy, who is clearly dependent on her alprazolam, using it addictively or appropriately? Is Sam, who gets withdrawal symptoms when he stops his pain medication, addicted to it or using it appropriately to treat his severe pain. The differences between addiction and dependence may seem like unimportant semantics to you but it's critically important to doctors and patients.
EricinNC wrote:I can go off my antidepressant and dont experience the "withdrawal" I experience by going off even small amounts of klonopin. Antidepressants are not controlled substances.
Antidepressants aren't controlled substances because they don't lead to addiction. Some of them can, however, cause severe withdrawal symptoms (venlafaxine/Effexor and paroxetine/Paxil are especially famous for this), which means they can cause physical dependence. This is a great example of the huge difference between addiction and dependence.

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