The end of methadone and the end of apnea...

[ameriken]

Anyone who has read a few of my posts knows the struggle I've had on ASV. Despite finally finding a good pressure that lowered my AHI to a consistent 5 and under, my PTB's (patient triggered breaths) ran as low as 37%...meaning that for 66% of the night I don't even try to take a breath. The ASV literally became a ventilator during those times. Despite an AHI of 5 and under, I still woke up in the mornings with that run-over-by-a-truck feeling that took two hours for me to wake up from.

The suspect in my apnea is methadone, which I take for my back since I have scoliosis with sciatic and other lower back, hip, and leg pain. Methadone has successfully battled the majority of pain, where all the other narcotics failed over the past 15 years. However, methadone, my panacea for pain, may be the very thing that has caused my bout with apnea (as suggested by the Dr. in my sleep study).

I've read reports and studies linking methadone and apnea. Methadone is also a killer...if someone starts out on 20 mg's of methadone and takes 50 mgs, that may be the last dose they ever take because it can completely shut down their respiratory system.

But methadone was was so successful at finally curbing my pain, I didn't want to believe the Dr's notes and I tried to convince myself there was something else going on. I thought the ASV would just take care of my breathing for me and I could sleep better and still manage my pain. But there was one major problem: I wasn't feeling better with the ASV, regardless of my AHI. Even with the addition of O2 in December, I still would not feel better. Could it be that the methadone is not only causing hypoventilation, but is also screwing around with the exchange of gases (O2 to CO2) when I breathe, or is it doing something else that is far beyond the ASV capabilities to handle?

I don't know the answer to that question, but I do know this. I recently started cutting back on my methadone. As for the pain, there is a substitute. Recently, someone told me how successful they had been with legal medical MJ for their pain. That got me to thinking. My chronic pain qualifies. Suppose I just start cutting back on the methadone, and try to qualify for something else?

Anyhow, for the past couple of weeks I've been doing just that...reducing my methadone intake while managing my pain, and things seem to be getting better. What followed is a huge improvement in my PTB's (all 90 to 97%) and I'm feeling a bit better. A a result my BPM's have gone from 11 to about 15. I've lowered my IPAP pressure back from 7 to my prescription setting of 5 and I'm maintaining a fairly steady 5 and under AHI. It sometimes seems like the ASV is hardly working (meaning I'm in a slow, steady, easy breathing pattern where the machine hardly intervenes).

I'm cutting back slowly but I imagine in a few weeks I can be completely methadone free. I have pain management now without the side effects. My wife notices a difference and tells me I look better, and I do feel better.

I have no intention of getting off the ASV for the time being and will continue to watch and feel my progress adn report to my Dr what I am doing. However I have been wondering lately if one day in the next few months I will have ended this saga of methadone induced central sleep apnea? Only time will tell.

Moral of the story: be very wary of opiates generally, methadone specifically.

[ameriken]

Some related reading:

viewtopic.php?f=1&t=73069&p=688665&hili ... ne#p671550

viewtopic.php?f=1&t=68121&p=633041&hili ... ne#p632998

[hades161]

Best wishes my friend and I hope that with or without pains meds you find some good ol peaceful sleep( No Dieing )

Keep us in the loop =) Maybe post a few reports with this other pain management technique.

[ameriken]

Thank you Hades...here's two, one before, one after.


Jan 18, 2012 (Before):







March 20-21 (After):

[Kody]

Ken that is great news and yes I think your really on to something here. I have noticed that the PTB's seem to have a major effect on how I feel the next day also. Mine are "usually" in the high 90's. However the last couple days for what ever reason they have fell into the low 80's. Even though I still had 5's and under, felt VERY BAD both days. My data looked very good, except for the PTB's, so that was the first thing I thought of why I felt so lousy.

I hope you will be successful in getting off the methadone and finding other avenues for your pain control. Please keep us updated on your progress.

So were your centrals the whole reason for you being on the ASV in the first place? Taking that further is there a chance you can get off a machine altogether if your completely off the medication?
Good Luck working all this out.

[ameriken]

So were your centrals the whole reason for you being on the ASV in the first place? Taking that further is there a chance you can get off a machine altogether if your completely off the medication?

Hey Kody...keep a good eye on those PTB's. Whenn you get into the 80's you can really feel it, as you've found out. Our machine may keep us going at 10 bpm, however that can be a huge difference if we normally breathe at 15 bpm.

Yes to both questions. I'm thinking if the methadone was the actual cause, then getting off it will enable me to stop using the machine. Though, I'm not ready to just jump off the ASV, I'm going to keep a close watch on the #'s and see how they follow the slow reduction in medication.

[Kody]

Looking at the Data, Wow tremendous difference, that's fantastic. Looks kind of like mine, but your missing a few dozen hypopneas I still have.

I started out with JUST obstructive no centrals. However increased pressure from regular cpap to get rid of the OA's brought about the Centrals, hence the Comp Sleep Apnea, and the ASV machine. However in your case if your issue was just Central's in the first place caused by the med's, and you get off the med's causing them, would make sense you wouldn't need any xpap at all. Guess they only way to make sure before you stop would be get one last sleep study. That would be great for you, of course makes our ASV club even smaller but we can live with that.
Kind of like in the movies when one of your cellmates makes parole, and you watch him walk out for the last time.

[sandman19]

Happy for you!

[ameriken]

.

Thanks Kim.

Yet another good night...all apneas I might have had were reduced to hypopneas, which I believe is a good thing (a partial breath is better than no breath).

For a couple of weeks now, I've had the ASV back to my lower prescription settings of IPAP=5, EPAP=7. Just months ago I that pressure resulted in an AHI of 10 to 20 with the ASV pumping outrageous pressure bursts to maintain my breathing. That is when I pushed the throttle up to 8 to have a better base of pressure, and that brought my AHI under 5.

But now back at the lower settings, my PTB's are consistently in the mid-90's and BPM's at 15. Since my breathing is starting to normalize, the machine is working in a quiter and more relaxed mode and is intervening less frequently. The caveat is with less methadone in my body, the lower back, hip, and leg pain have returned. Fortunately, my alternative pain med is working well.

Today I dropped another 5mg's on the methadone and will hold this for a week or two before doing so again.

[Pugsy]

Looking good Ken.
I wondered early on about the effects of the Methadone on the respiratory drive but didn't figure it was my place to offer that idea. I figured your doctor would have considered that factor at the beginning. Having to deal with pain issues myself, I figure it is not my place to comment on what drugs people have to use. If your alternative pain medication is holding things to a comfortable enough level then I am very happy for you.

If you end up not even needing a machine..that would just be too cool. While I don't really mind the machine...I can sure relate to how nice it would be to not need it.

[ameriken]

Thanks Brenda, the doctor touched on it and methadone was mentioned as a culprit, but I think they too didn't want to get too critical about the pain med because it was working, which in a way I appreciate that. But I was my own worst enemy, I didn't want to face going off the methadone since that meant the daily pain would come back which affected my life about as badly as the sleep apnea. I was tired, grouchy, didn't want to do anything, etc.

Anyhow, I too don't mind the machine either and will be slow and hesitant about getting off it.

BTW, Brenda....thanks for all your help through this, you're a gem.

[Kody]

Wow Ken those results look very good! You even passed my average breath rate, which is about 12.5 Does this mean you can kick the 02 additive as well?
Keep us updated this is very interesting progress.

[ameriken]

Wow Ken those results look very good! You even passed my average breath rate, which is about 12.5 Does this mean you can kick the 02 additive as well?

Hi Kody, I am hoping I can get off the O2, my only hesitation to doing so is I am a breath away from being diagnosed with COPD (pun intended) and some of the desats could be non-apnea related. Something I want to talk to the Dr about before I stop doing anything.

[hades161]

Take it slow and easy man. Don't try to push to hard to fast.

I haven't researched methadone withdrawal but a fast Google check I see it might be difficult, and include physical withdrawal issues. Have you talked with your Doctor about stopping the Methadone and what you might experience?

[ameriken]

Take it slow and easy man. Don't try to push to hard to fast.

I haven't researched methadone withdrawal but I just from a fast Google check I see it might be difficult, and include physical withdrawal issues. Have you talked with your Doctor about stopping the Methadone and what you might experience?

Thanks...I know it may seem I'm pushing too fast, but rather I'm taking my time at it...been there done that with other opiate pain meds and I'm very familiar with the withdrawal symptoms, etc. I'm taking a long, slow, gradual process of reducing the daily intake about every week or two. It could be another 5 to 10 weeks before I'm off or close to being off.