Benzodiazepines Potentially Fatal for OSA Patients

Here's a quote taken from "The American Psychiatric Publishing Textbook of Psychosomatic Medicine" (2005 edition) on page 890/891:

"Benzodiazepines should be used with caution in patients with compromised respiratory function or seizure disorders. Use in patients with obstructive sleep apnea is potentially fatal. (Dolly and Block 1982)(see Chapter 16, "Sleep Disorders") "

You could find this textbook on Google books.

I'm going to ask my doctor about this. This would explain the great difficulty I had when I had to take Lorazepam.

Has anyone else heard about this warning?

I haven't heard that warning specifically, but benzos often cause sedation, and sedation often causes respiratory depression, which would certainly be one of the last things someone with sleep apnea would want. They also cause central nervous system depression, which can cause respiratory depression, etc. It's also been noted that apnea can be a direct side effect of IV administration of benzodiazepines, so all things considered, "should be used with caution" seems a very reasonable warning, and "potentially fatal" seems logical, as well.

I don't use benzodiazepines, but I do occasionally use hydrocodone, an opioid, due to problems from a spinal injury, and I can say for certain that my AI numbers are higher on the nights I use them, presumably for the same reasons.

Hi joe989

Some doctors prescribe Benzodiazepines, as though they were candy. Like Catnap, I hadn't heard that warning, but they are such downers for all your systems, I wouldn't be surprised.

[quote]SIDE EFFECTS: This medication causes drowsiness and dizziness. Avoid tasks requiring alertness. Other side effects may include: stomach upset, blurred vision, headache, confusion, depression, impaired coordination, change in heart rate, trembling, weakness, memory loss, hangover effect (grogginess), dreaming or nightmares. Notify your doctor if you develop: chest pain, change in heart rate, vision changes, yellowing of the eyes or skin. In the unlikely event you have an allergic reaction to this drug, seek medical attention immediately. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

Valium, Versed, Klonopin, these are all benzodiazapines. Valium and Versed are commonly used for "conscious sedation" for colonoscopies and endoscopies for their amnesia effects.

I can say the night after my colonoscopy with versed my AHI was scary high. It was normal the next night. Versed definitely affected my AHI and sleep.

My sleep doctor prescribed me Klonopin for my insomnia. I like it better than Ambian or Ambian CR because after taking them I felt like I had had a frontal lobotomy. I don't feel any side affects from Klonopin. I had my check-up appointment with him yesterday and asked him about the fact that it was a depressant and isn't that bad when you have sleep apnea and he said as long as you were using your mask it wasn't a problem, but it would be if you weren't being treated. Even though I am still more tired than I would like to be, my AHI is low.

izzyb wrote:My sleep doctor prescribed me Klonopin for my insomnia. I like it better than Ambian or Ambian CR because after taking them I felt like I had had a frontal lobotomy. I don't feel any side affects from Klonopin. I had my check-up appointment with him yesterday and asked him about the fact that it was a depressant and isn't that bad when you have sleep apnea and he said as long as you were using your mask it wasn't a problem, but it would be if you weren't being treated. Even though I am still more tired than I would like to be, my AHI is low.

My doc gave me clonazapam (klonopin) for my occassionaly anxiety attacks and trazedone to help me sleep. I told them I didn't want to be on an addictive sleep aid that left me groggy the next day (lunesta, ambien, sonata) so he suggested this. Rozarem is a sleep aid that is said to help with insomnia, but WAY expensive. Trazedone works great for me and is on the generic formulary list.

I'm glad I've got the warning now! I'm glad i'm still alive and kicking. Who knows the risks I'd taken in the several years I had UNDiagnosed OSA. Though I've only been using CPAP for about 60 days now, I've promised myself that I'll never nap without CPAP.

I have taken Lorazepam for 18 years now. I take only 1.5 mg each morning for an atypical migraine condition.

I was daignosed with sleep apnea in 2002, 7 years ago. I still take the small dose of Lorazepam. As I said, I take in the morning with breakfast.

The Sleep Specialist had no problem with it when I was diagnosed. He said the dosage was too small to do anything but it has kept my atypical migraine symptoms under control for 18 years. I have decreased it over the years but never increased the dose and can't get lower than the 1.5 mg without symptoms appearing.

I know it is an addictive drug but, for some situations, there are choices that must be made.

klockemy, it is good to hear something positive about trazedone because I asked my doc yesterday about it. I had read about it being an antidepressant also and I wanted to try it. I have had a problem with side effects from just about every other antidepressant but thought I would give this a try since it would kill two birds with one stone. So he prescribed it for me to try. I haven't picked it up yet, but can't wait. I am hoping this helps both my problems, but if it doesn't I'll go back to Klonopin since it seems to work pretty good at helping me sleep. It's not perfect. I still wake up earlier than I would like, but it has been the best thing I've tried. The most I've taken at a time is 1 1/2 (I'm not sure if that is mgs or what), but I may start taking 2 since my doctor acts like it is no big deal. Maybe I'll sleep until my alarm goes off then. He also said that there doesn't seem to be much problem with tolerance with it. I hope he is right. My regular doctor told me that Rozeram takes a while to work (I don't remember how long) and she said you can't take anything else at the same time while you are waiting for it to work so I didn't try it. I can't go without sleep for weeks waiting to see if something works.

joeb989 wrote:"Benzodiazepines should be used with caution in patients with compromised respiratory function or seizure disorders. Use in patients with obstructive sleep apnea is potentially fatal."

Well, careless talk is careless talk, whether from doctors or not, whether published or not.

Use of virtually ANY medication in virtually ANYONE is potentially fatal, since
a) most medications DO SOMETHING in the body, and
b) most medications DON'T do ONLY ONE THING in the body.

A more prudent statement would have been that use of any respiratory or CNS depressants in UNTREATED patients with OSA is dangerous.

Appropriate use of appropriate medication to improve the sleep of patients with OSA (many of whom have more than just one sleep-related pathology) is .... appropriate.

Benzos are the worst poison that the medical community has ever created. The withdrawal is worse than heroin withdrawal and far longer...like 18 months. Stay away from benzos unless you take it like once a month or so.

Gary