Ambien

Quick Question - has Ambien been known to aggravate apnea, making numbers much worse? If so, what is it about drug that causes it?

Ambien induces sleep which can block or subdue signals to receptors in the brain. This can cause the brain to forget to breathe causing CA's, as well as, relaxing the throat muscles to a point that your airway becomes restricted causing OSA's. My AHI changes on the nights that I have used zolpidem as opposed to the nights that I haven't.

I'm sleeping better, but my numbers have tripled from about 4-5 to about 12-15. I wonder if taking CR would be better instead of getting 10mg released at once. Only issue there is insurance won't cover CR.

jnew71 wrote:I'm sleeping better, but my numbers have tripled from about 4-5 to about 12-15. I wonder if taking CR would be better instead of getting 10mg released at once. Only issue there is insurance won't cover CR.

You would need to look at what types of events you are having to see what that means. Have you looked at a report to see what it going on?

This was the one the night before - I'm also having issues during waking hours with breathing. I've already been through a battery of tests in the ER last week. I initially thought it was the static pressure that was set to 10.5 after the 30 day APAP trial, so I bumped it down, but still having same side effects after a few days without -

jnew71 wrote:I'm also having issues during waking hours with breathing.

I wouldn't be using Ambien until I got that under control first.

As for your charts, I am no expert, but it would appear your pressure is not high enough to handle the events you are having.

I agree about the pressure - 10.5 was taking away everything except for some CA's, which I attributed to sleepless nights. However, I attributed the breathing issues during the day to an increase in pressure which in hindsight, doesn't make sense because the 10.5 was based off of the 90% pressure reading. I guess I was getting that much most of the time anyway? I never thought the Ambien would cause the issues I'm seeing, but perhaps it is.

I take 10mg of Zolpidem (generic Ambien) nightly and have great numbers.
AHI is usually less than 2 but often less than 1.

Bryansong

It does look as if your pressure is too low. Ambien could cause an increase in AHI for the reasons stated above (deeper sleep - more relaxed, greater tendency for OSA, etc.); However, the pressure could be set to overcome that. I think the first thing you should do is reevaluate the your basic pressure needs. Try a night without Ambien and see what happens. If you have OSA, increase the pressure and try again. Remember that an increase in pressure will not prevent central apneas, so if CA's increase with an increase in pressure you will want to stop. If CA's remain predominant, you will probably want to see your doctor. It is not clear why you chose 7.5 if your 95% pressure was 10.5?
Can you reset your machine for another 30 days in the Auto mode? Perhaps you are the type of sleeper that needs an auto machine, or something even more advanced.

jnew71 wrote:I agree about the pressure - 10.5 was taking away everything except for some CA's, which I attributed to sleepless nights. However, I attributed the breathing issues during the day to an increase in pressure which in hindsight, doesn't make sense because the 10.5 was based off of the 90% pressure reading. I guess I was getting that much most of the time anyway? I never thought the Ambien would cause the issues I'm seeing, but perhaps it is.

Two things...when you increase your cpap pressure, that can cause you to have more centrals. So when I change my pressure, I watch for that. You can raise your pressure and see about the same number of OSA's, but more centrals.

The other thing is that a lot of people will always show some centrals. For example, I didn't have any in sleep study, but on cpap I have some centrals. Not enough to worry about. My sleep doctor tells me not worry about them at the level that I have them, it can come from using cpap, or not breathing when you roll over in bed...it only takes 10 seconds for a lapse in breathing to be labeled a central by a cpap machine. And they can come and go.

I only used Ambien for a week, 3 years ago, but I don't think that it affected my AHI while I was using it. That sounds like an individual thing to me *smile*.

Jay Aitchsee wrote:It does look as if your pressure is too low. Ambien could cause an increase in AHI for the reasons stated above (deeper sleep - more relaxed, greater tendency for OSA, etc.); However, the pressure could be set to overcome that. I think the first thing you should do is reevaluate the your basic pressure needs. Try a night without Ambien and see what happens. If you have OSA, increase the pressure and try again. Remember that an increase in pressure will not prevent central apneas, so if CA's increase with an increase in pressure you will want to stop. If CA's remain predominant, you will probably want to see your doctor. It is not clear why you chose 7.5 if your 95% pressure was 10.5?
Can you reset your machine for another 30 days in the Auto mode? Perhaps you are the type of sleeper that needs an auto machine, or something even more advanced.

jnew, I went back and reviewed your posts in other threads and I'm going to amend my above slightly. I think it's possible you are trying too hard, changing your therapy too often, not allowing your body to become accustomed to the treatment. Once a change is made - pressure, mask, etc., I think you should allow several days for your body to adapt, at least three and better a week. I get the idea you're changing nightly, chasing AHI. Remember that nighty changes in AHI are normal and an AHI less than 5 is considered normal. A decrease in absolute AHI does not necessarily mean you are sleeping better or are going to feel better. Also, you could have issues in addition to OSA which affect sleep and cause fatigue.

Jay Aitchsee wrote:

Jay Aitchsee wrote:It does look as if your pressure is too low. Ambien could cause an increase in AHI for the reasons stated above (deeper sleep - more relaxed, greater tendency for OSA, etc.); However, the pressure could be set to overcome that. I think the first thing you should do is reevaluate the your basic pressure needs. Try a night without Ambien and see what happens. If you have OSA, increase the pressure and try again. Remember that an increase in pressure will not prevent central apneas, so if CA's increase with an increase in pressure you will want to stop. If CA's remain predominant, you will probably want to see your doctor. It is not clear why you chose 7.5 if your 95% pressure was 10.5?
Can you reset your machine for another 30 days in the Auto mode? Perhaps you are the type of sleeper that needs an auto machine, or something even more advanced.

jnew, I went back and reviewed your posts in other threads and I'm going to amend my above slightly. I think it's possible you are trying too hard, changing your therapy too often, not allowing your body to become accustomed to the treatment. Once a change is made - pressure, mask, etc., I think you should allow several days for your body to adapt, at least three and better a week. I get the idea you're changing nightly, chasing AHI. Remember that nighty changes in AHI are normal and an AHI less than 5 is considered normal. A decrease in absolute AHI does not necessarily mean you are sleeping better or are going to feel better. Also, you could have issues in addition to OSA which affect sleep and cause fatigue.

Answering your first question, I changed the setting from 10.5 to 7.5 because of the side effects I was having with breathing during the day. I attributed those side effects to the constant pressure of 10.5. The 10.5 setting did take away everything except for CA's, but the breathing issues that drove me to ER caused me to retitrate for 5 days, thinking that the tweaking I originally did may have had an effect on the static pressure set. At the end of 5 days, it was set to 7.5. However, the side effects didn't go away and I said the hell with it, so I'm back to my original APAP mode settings and will let that run for 30 days like I should have in the beginning. I've also stopped taking the Ambien and we'll see.

You have a point about chasing, but it hasn't been about the AHI. It's been about comfort. When I first started, I was given the Wisp and couldn't breath with it. It took 2 weeks to get back in with my DME, so I adjusted the floor of my 5-20 range in the interim (.5 every 3-4 days until I was comfortable at a floor of 8 ). I also have chronic neck pain which interestingly enough, seems to be caused by my faulty breathing patterns, especially when stressed. So part of my chasing has been in an effort to reduce my neck pain, which was getting better as I learned to breathe correctly using my diaphragm - until I started CPAP. The difficulty in breathing as a side effect has increased my neck pain again to the point that I've considered giving up the CPAP. I honestly would rather have the pain reduction than the benefit of CPAP. My wife wouldn't agree, but she hasn't lived with 9 years of pain, just my moods as a result.

We'll see how the next 30 days go and move on from there. I've also made an appointment to see a pulmonologist just in case - I don't know that he'll find anything as they didn't in my ER visit. I've never come close to any respiratory issues before starting CPAP, so there seems to be a connection to that or the Ambien (still having the symptoms and haven't taken in 2 nights). Thanks for the feedback. It's much appreciated.

Jnew, I wish you the best with your therapy. Gathering some good solid data for a couple of weeks may give you some more insight as to your problems. It does sound as if you may have more than one issue to contend with. Pain from whatever source could be a culprit in raising your AHI. Pain could result in arousals, conscious or not, which could cause you to hold your breath (while you move or roll over, for example) which could cause the machine to score CA's which really aren't central in nature and wouldn't be scored in a lab. Notice there are a lot of "coulds" in the foregoing. Without an EEG., it is difficult to tell what's really happening. About the only thing that can be done at home is to rule things out one at a time. OSA is relatively easy, xpap treatment and SleepyHead can do that. Once OSA is controlled, you can move on to the next thing.
It may turn out that pain medication is going to be required for you to gain restful sleep. There are some members here who have successfully dealt with that issue, Pugsy comes to mind (maybe a PM to her is warranted). In any event, medication must be approached cautiously, since many can have an adverse effect on sleep architecture and the quality of sleep. Unfortunately, it seems many doctors prescribe medication without regard to the impact it could have on sleep. You may want to search until you find a doctor who is interested in treating both.
In any event, I think you're on the right track to take a methodical approach to your therapy and give yourself time to adjust. I think you're saying you're going back to 5-20 which is fine, but I think you made a pretty good case for 8-20 earlier and it does appear a straight 7.5 was too low. Your call. Good luck.

My sleep doctor prescribes ambien so I guess if it was bad he would do it. I use Xanax which is much cheaper and just as good and no increase in ahi.

Too tall wrote:My sleep doctor prescribes ambien so I guess if it was bad he would do it. I use Xanax which is much cheaper and just as good and no increase in ahi.

Except the half life of Xanax is about 3 times that of Ambien and thus more likely to cause a "drug hangover' the next day. Additionally, I believe but can't cite a source right now, that Xanax has a greater risk of dependency than Ambien.

See http://www.livestrong.com/article/13298 ... -sleeping/ for one person's comparison of the two.
http://www.drugs.com/article/benzodiazepines.html
http://www.rxlist.com/ambien-drug/clini ... cology.htm
http://www.rxlist.com/xanax-drug/clinic ... cology.htm
2.2 compared to 11.2