CSA and Opioids

I had pretty extensive knee surgery in early December and was prescribed and opioid pain killer.

The first couple of nights I slept normally but after that I noticed my AHI going up from an average of 2-3 to over 15 most of which were being classified as Centrals. In researching online I found several correlations between opioid use and centrals.

My question that I cannot answer would be after discontinuing the pain medication, how long does it typically take for your body to get back to normal? I will say last night was my best night as far as AHI goes...I was at 4.4...the night before I was at 15.2...I've been off the prescription for about 2 weeks now.

Edit..

Just to add some more info, in digging through my data in SH, my OSA numbers remained pretty normal...the higher AHI was almost always (like 99% the cause) because of the CSA and RERA events...sometimes with a hypopnea sprinkled in there.

Opoids can of course suppress respiration and central apneas happen when we don't breathe.

Also there is always the possibility that the cause for the taking of the pain meds is also a factor in higher AHI numbers (primarily centrals but can be any event) because we simply aren't sleeping so great because of the pain. When we don't sleep so great we have a higher chance of having SWJ sleep/wake/junk false positive flagged events elevating our AHI. Awake/semi awake breathing can be very irregular when compared to asleep breathing and these machines only measure air flow...they have no way to measure if we are asleep or not....so irregular breathing can and will be flagged as some sort of apnea event. In other words the poor sleep itself causes the flagging and not the flagging causing the poor sleep.

To help figure out if a flag is real (as in we were really asleep) or not real/SWJ flagged event we have to try to evaluate the breathing pattern itself to see if we were asleep or not. It's not always easy to distinguish though.
Go here and watch the videos
http://freecpapadvice.com/sleepyhead-free-software
It will help a bit in learning how to spot real asleep events from awake flagged events that aren't real.

If we aren't asleep....they don't count and we have to mentally removed them from the therapy evaluation process.
Instead we have to try to focus on why so much poor sleep in general and try to fix the poor sleep first.

Not long ago I had a higher than normal AHI of nearly 4.0 and it contained a nice mix of all the 3 categories of event flags...OAs, centrals and hyponeas. I took the time to go look at the breath by breath flow rate to see how many were real and I was asleep vs how many were not real...every single one of the flagged events was related to awake breathing or post arousal breathing irregularities.
I just had a crappy night's sleep. Lots of tossing and turning and remembered awakenings because my back hurt worse than normal.

So if it has been 2 weeks since you took any pain medication then most likely any centrals you see flagged aren't related to pain meds suppressing respiration but they might be more related to pain or discomfort associated with the surgery you had that caused you to need pain meds in the first place.
Now you might have a few more real centrals related to sleep onset (those are normal to have) because you have more arousals and with more arousals you have more going back to sleep transitions which in turn increases the chances of having normal sleep onset centrals.

So how's the sleep quality going now? Still having much discomfort or frequent awakenings and tossing and turning?

Thank you for the info.

As far as I can tell, I am sleeping through the night....not waking up in any pain. For the first week or so I would wake up in the middle of the night to use the bathroom due to the amount of fluids I had to take in due to using the pain medication. I'll dig in to the respiration and see if I can determine any patterns.

Again, thank you for the info.

I don't know what kind of surgery you had or when you had it but I always allow 4 to 6 weeks (at least) post surgery before I would start worrying about major changes in the software reports in terms of AHI or types of events.

A little off topic (expanded really), it is known by some doctors that pain medications can reduce "REM" sleep down to near zero. Also, Xanax which is often given as a sleep aid can reduce "deep" sleep too near zero (I do not know if other benzos have the same effect or not). In my case, I was taking both for different reasons and I was wearing a "Zero Sleep Monitor" at the time. My deep sleep was near zero the entire time that I had the Zero, and for the time that I was taking a high dose of pain medications, my REM sleep also took a deep dive to near zero. Needless to say that with no deep or REM sleep I was totally worn out all day. It was not in until after I reduced my pain medication needs that I noticed that my REM sleep started to return. I was plotting my Zero data in a large database when I noticed the pain medication correlation with loss of deep sleep and I realized what may have happened. This plot was after I had reduced my pain medication. So it was really a double-blind test. I didn't know that I was being tested and did not know what I was tested for - LOL. I gave my results to my pain doctor and he told me that he had heard of pain meds reducing REM sleep, but had never seen any proof of it doing so (not many people wear a brainwave monitor for months). (BTW - - This was all before I developed SA.)

Lessons learned:
1. Xanax kills deep sleep.
2. Pain medications can reduce, or eliminate deep sleep.
3. Do not expect your doctor to have a clue about either situation, which can leave you in a constant state of "light" sleep only, even without having any SA problems. You have to do your own research when taking any medication to see how it may screw-up your life.