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

Postby BrianinTN on Mon Mar 14, 2011 12:46 pm

I've read that benzos (such as klonopin/clonazepam) can exacerbate sleep apnea. My question is: for those of you with some experience here, by how much?

Background: In my sleep studies last summer, despite taking Lunesta in one and Ambien in the other, I couldn't settle down at all. So, for my third and latest study a few weeks ago, I added 0.5 mg of clonazepam to a bedtime Lunesta. Because my prescribed pressures (20/16 BIPAP) came back significantly higher than they had been set at in a study just 9 months prior (13 CPAP), I'm wondering if my meds contributed to my situation at all.

Most of what I've read hasn't been terribly quantitative, so I'm hoping some of you might be able to weigh in and offer an opinion. Such a small amount of clonazepam seems like it would have little to no impact, but what do I know? :D Thanks!

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Last edited by BrianinTN on Sun Mar 20, 2011 3:43 pm, edited 1 time in total.
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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Postby DreamDiver on Mon Mar 14, 2011 12:51 pm

BrianinTN wrote:I've read that benzos (such as klonopin/clonazepam) can exacerbate sleep apnea. My question is: for those of you with some experience here, by how much?

Background: In my sleep studies last summer, despite taking Lunesta in one and Ambien in the other, I couldn't settle down at all. So, for my third and latest study a few weeks ago, I added 0.25 mg of clonazepam to a bedtime Lunesta. Because my prescribed pressures (20/16 BIPAP) came back significantly higher than they had been set at in a study just 9 months prior (13 CPAP), I'm wondering if my meds contributed to my situation at all.

Most of what I've read hasn't been terribly quantitative, so I'm hoping some of you might be able to weigh in and offer an opinion. Such a small amount of clonazepam seems like it would have little to no impact, but what do I know? :D Thanks!
I take .5mg clonazepam very occasionally for pain. I have noticed no change in AHI for myself on nights when I take it. I have no experience with Lunesta or Ambien, but I think Muse-Inc told me once that ambien does not negatively affect sleep architecture.

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

Postby Pugsy on Mon Mar 14, 2011 1:13 pm

I haven't taken any Clonazepam so I can't comment on it. I have taken an occasional generic Valium 5mg at bedtime and saw zero difference in the reports. I also more than occasionally take a generic Hydrocodone/APAP 5/325 at bedtime and no change in stats.
In theory they are supposed to "relax" the tissues more and I would then assume increase the chance for more events. Now I do have an APAP but I didn't see anything different from the other nights. No particular increase in pressure to maybe ward off something new or harder to treat. I would expect that these type of meds could very well impact others in a different manner. Just like any med might.

In my case it was discussed with the sleep doctor and decided that the maybe minor impact of the meds was more than offset by my need to get some sleep. Sometimes pain is such that sleep was so fragmented and brief that it didn't matter how effective my therapy was because sleep quality was hugely impacted. So my choice was no sleep and feel awful or minor med and get some sleep even it it "might" be impacted a little by a small dose.

I don't need the Hydrocodone as much now with the new bed but last night I took one because I laid new tile floor in the kitchen and finished the grouting last night. I hurt all over..... No change in the report this morning when compared to other nights without extra meds.

No experience with Lunesta but I have a script for Ambien. Again, not needed as much since back pain has lessened but I did take it regularly for quite a while and no change in reports. Ambien doesn't seem to mess with sleep architecture. This is why it is often prescribed in conjunction with a sleep study. No sleep means no study and it is hard for some people to sleep in the sleep study environment.

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

Postby roster on Mon Mar 14, 2011 1:32 pm

BrianinTN wrote: Because my prescribed pressures (20/16 BIPAP) came back significantly higher than they had been set at in a study just 9 months prior (13 CPAP), I'm wondering if my meds contributed to my situation at all.




"Often" lab sleep studies are no better than a guess at what your pressure should be.

The best thing to do is to use the software to optimize your treatment at home in your own bed and under the conditions in which you normally sleep (see viewtopic.php?f=1&t=60874&p=570977).

The software also gives you the data to see the effects of adding, increasing, or decreasing medications.

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Last edited by roster on Mon Mar 14, 2011 1:39 pm, edited 1 time in total.
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Re: Clonazepam/Sleep Meds & Apnea: Extent of Causal Link

Postby roster on Mon Mar 14, 2011 1:39 pm

Brian, I just now looked at an earlier post of yours. You seem to be concentrating on average data. I rarely look at averages. The daily details are much more informative of what is going on throughout the night. Averages can be misleading.

Also, since you have big differences in prescribed pressure requirments, use the daily details report to evaluate yourself for positional sleep apnea - see viewtopic/t43360/viewtopic.php?f=1&t=43360&p=384179#p384179 .

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

Postby Pugsy on Mon Mar 14, 2011 1:42 pm

Brian which machine do you have? Your humidifier points to the new PR System One humidifier yet your machine shown points to a much older machine that has been discontinued for quite a while.

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

Postby john.michael on Mon Mar 14, 2011 1:57 pm

My sleep doctor recommended ambien during the sleep study. In his words, "Ambien does not affect breathing at all"

My diagnosis is "Primary (Idiopathic) Central Sleep Apnea" (CSA) Meaning, there is no other primary cause such as heart disease or altitude for the Central Apnea, and there has been no identified root cause at all.

My GP, when researching this for me since he had never heard of Central Sleep Apnea before me, found some articles with the same information that the original poster provided that the benzo family of medications can exacerbate sleep apnea. As I recall, there was no distinction between Obstructive and Central Apnea. I also vaguely recall that the paper explicitly excluded benzos as a primary root cause, but as stated, "can exacerbate."

While I have been prescribed benzos in the past, it was many months before my sleep study that I had last taken any. I used them for short periods (1-3 weeks, non-consecutive days, max) and in low dosages. I guess there is no way to know for sure, but both my doctors have dismissed them as causing or exacerbating my CSA.

When I read that opiate use / abuse can cause CSA, I was initially concerned because I had a codeine based cough syrup beginning 6 weeks before the sleep study and ending 3.5 weeks before the sleep study. My sleep doctor rejected that as a possible cause.

For the original poster, BrianinTN, I certainly have no idea to what extent 0.25 mg of clonazepam affected your sleep study. Did you tell your Dr that you took it? Do you feel comfortable asking your Dr?

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

Postby BrianinTN on Mon Mar 14, 2011 2:39 pm

Sorry about the confusion on the equipment -- machine updated. There are so many options listed; I guess I got the old model and the new one confused! I have the current BiPAP S/T.

I did consult with the sleep technician about what meds I was going to take prior to the study, and I had talked with the doctor as well (although not in quite as much detail). The doc's response was, generally, "We need you to get some sleep so we can get a reading, so if you need to take meds to do so, OK." His general attitude was that while in a perfect world he'd rather me not be taking anything, the tradeoff was worth it.

The reason I'm a bit concerned, as roster alluded to, centers on my earlier post (viewtopic/t61453/BiPAP-ST-User-Machine-amp-Data-Questions.html). The index values I mentioned there are high, and I actually had been looking at the daily reports (although after only 4 days now on the BiPAP, there's not too much difference between the two). I'm routinely getting Hypopnea Index values night after night that are in the 20-25 range. I also switched from the new FitLife mask back to my old F&P 432 (side sleeping felt impossible on the FitLife); the CA Index numbers are now around 8-10 per night on the F&P, while they were around 1-2 on the FitLife.

Other than maybe trying to force myself to sleep on my side versus my back, what suggestions might y'all have? Sounds like the consensus is that the meds are probably not to blame for any of this. I have a call into the doc to get his reaction, but so far no word... Right now, roster, I'd kill for just the first report you linked in the other thread -- never mind the second! :)

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

Postby Hawthorne on Mon Mar 14, 2011 3:07 pm

I take a low dose of a Benzodiazepam (1 1/2 mg) every morning for a condition other than sleep apnea or sleep.

I have taken it for 30 years now and was not diagnosed with sleep apnea until just over 8 years ago.

I didn't sleep well at my sleep studies at all bur was titrated at a pressure of 10 cm. I have the software for my machine and my AHI is almost always below 2 so I would say it does not affect my sleep. As I said though, I take it in the morning not at bedtime.

Of course I can't speak for anyone else.

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

Postby Mary Z on Mon Mar 14, 2011 3:20 pm

My Psychiatrist told me that my 0.5-1 mg Klonopin was too small a dose to affect my Sleep Apnea.

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

Postby klutzo on Mon Mar 14, 2011 3:44 pm

I have taken .25 mgs. of Xanax at bedtime for 25 years to prevent muscle spasm from Fibromyalgia, secondary to my Lyme Disease. If my lower back hurts really bad, I will take .5 mgs. I also take an extremely sedating blood pressure medication called Clonidine, and I take two 0.2 mg. doses during the night, which is quite a large dose.

Before CPAP, I had hypopneas at 29 per hour. In my 4 yrs. on CPAP, my AHI has stayed right around .8 per hour. That's pretty good, so I doubt it's affecting me much. What it's doing to my memory is another story.....what forum is this again, lol?

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

Postby roster on Mon Mar 14, 2011 7:47 pm

BrianinTN wrote: Right now, roster, I'd kill for just the first report you linked in the other thread -- never mind the second! :)



It took me quite a while to get to the first report and then some more time for the second. It sounds like you are off to a quick start and with some persistence will make the goal.

That F&P 432 is a good mask for side sleeping or tummy sleeping ( see Falcon position viewtopic.php?f=1&t=36738&st=0&sk=t&sd=a&start=15 ). I use that mask as a backup to my Innomed Hybrid mask. I sleep most of the night on my tummy and part on my sides using a small backpack to prevent backsleeping.

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

Postby BrianinTN on Mon Mar 14, 2011 9:49 pm

roster wrote:
BrianinTN wrote: Right now, roster, I'd kill for just the first report you linked in the other thread -- never mind the second! :)



It took me quite a while to get to the first report and then some more time for the second. It sounds like you are off to a quick start and with some persistence will make the goal.

That F&P 432 is a good mask for side sleeping or tummy sleeping ( see Falcon position viewtopic.php?f=1&t=36738&st=0&sk=t&sd=a&start=15 ). I use that mask as a backup to my Innomed Hybrid mask. I sleep most of the night on my tummy and part on my sides using a small backpack to prevent backsleeping.


Thanks. I have two follow-up questions for you then, since you seem super familiar with most of these facets! First, what do you make of my hypnopneas? Is that something you expect will just go down with time, or is this going to be more of a playing with pressures/positions thing? I always go to sleep on my back (I may try the Falcon position you linked, but I'm not sure how natural it will feel), but I think in my sleep I wind up on my back sometimes. I may try to get a couple pillows or something to force me to stay on my side.

Second, I find myself waking up a lot with the F&P 432. I do like how it feels overall, and it's super quiet compared to the FitLife -- when it's not leaking. I feel like I'm awakened at least a dozen times a night needing to adjust it -- better than I was doing with the ComfortGel Full which was awful, but still not good. As I'm getting more centrals (8-10 an hour) with the F&P than with the FitLife (1-2), what do you make of that? Do you think it's perhaps the centrals waking me up, or the mask, or both?

Thanks again.

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

Postby roster on Tue Mar 15, 2011 6:09 am

BrianinTN wrote:
Thanks. I have two follow-up questions for you then, since you seem super familiar with most of these facets! First, what do you make of my hypnopneas? Is that something you expect will just go down with time, or is this going to be more of a playing with pressures/positions thing? I always go to sleep on my back (I may try the Falcon position you linked, but I'm not sure how natural it will feel), but I think in my sleep I wind up on my back sometimes. I may try to get a couple pillows or something to force me to stay on my side.

Second, I find myself waking up a lot with the F&P 432. I do like how it feels overall, and it's super quiet compared to the FitLife -- when it's not leaking. I feel like I'm awakened at least a dozen times a night needing to adjust it -- better than I was doing with the ComfortGel Full which was awful, but still not good. As I'm getting more centrals (8-10 an hour) with the F&P than with the FitLife (1-2), what do you make of that? Do you think it's perhaps the centrals waking me up, or the mask, or both?

Thanks again.



Excellent questions to ask; bad questions to give direct answers to.

I say work with the daily details report. Maybe even keep a journal of your impressions of what happened during the night and how you felt throughout the next day. It can take some time and experimentation to find a mask that works well for you. It is the same for a sleeping position.

Make notes in the journal as soon as you wake up and if you can't get to the daily details report until after work, compare it to your journal notes. Pay particular attention to the leak line.

If you want to paste one or two of the daily details reports here, you should get some good comments and help with interpretation.

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

Postby BrianinTN on Tue Mar 15, 2011 10:23 am

Irrelevant - deleted

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Last edited by BrianinTN on Sun Mar 20, 2011 1:57 am, edited 1 time in total.
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