Numbers good, feel bad? Maybe it's your Meds

I've noticed that many people complain that they have their numbers in line, but still don't feel they're getting the rest they should. One possibility might be the medications taken. I started to do a little research project on which meds might cause insomnia, disturbed sleep, or daytime drowsiness and found that nearly all the medications we apneacs are apt to take fall into that category. So, rather then list all the meds, I've gathered together some of the more common for your review along with some sources. I think it's probably common for medicos to prescribe a medication, especially anti-depressants, for a particular symptom without regard to the impact it may have on sleep. If you can find no other reason for not feeling rested, maybe a good look at your meds would be in order. Remember these are meds that might cause disturbed sleep, not necessarily do. As always, consult your Doctor for advice.
Jay

Medications which can cause disturbed sleep, insomnia, non-restorative sleep, or daytime drowsiness.
(some of these meds put us to sleep, but don't allow or promote deep restorative sleep)

Over the Counter Meds
antihistamines, decongestants, cough medicines, pain relievers containing caffeine, alcohol, and most OTC sleep aids

Presciption Meds
For non sleep related conditions: anti-arrhythmics, beta blockers, statins (Zocor), asthma medications, SSRI anti-depressants.
Often for sleep related conditions: SSRI anti-depressants, anticonvulsants such as Neurontin, Klonopin; muscle relaxants such as Zanaflex; anti-anxiety meds such as Xanax, Valium, Tranxene, most other benzodiazepines and sedatives.

Though not without side effects, Ambien and Trazadone seem to be the lesser evils in the sleep med category.

References:
http://www.psychiatrist.com/pcc/pccpdf/ ... 3n0303.pdf
http://www.healthcentral.com/sleep-diso ... ation.html
http://www.drrodger.com/sleepdisorders.html
http://thechart.blogs.cnn.com/2011/06/0 ... -hangover/
http://www.everydayhealth.com/sleep/med ... sleep.aspx
http://www.sleepfoundation.org/article/ ... d-insomnia

my data is very good,No apnea's,No leaks,Good deep Sleep!! i feel soooo bad during the day!! still tired as!! i have No other Meds at all,None!! still having tests to see why im still daytime tiredness!! just blood tests and E.N.T appointments!! but in most people yep Meds maybe the reason!!

Other reasons for feeling not so great despite "great numbers".

Pain.
Fragmented sleep for any reason.
Simple bed comfort.
Hours of sleep using the machine. 5 or 6 hours is not enough for most people.
External forces out of our control that mess with sleep.
Meds that are stimulants that carry over to the night and we don't sleep well or can't go to sleep.
General health issues.
Caffeine.
Poor sleep hygiene.
I am sure there are others, just drawing a blank at the moment.

I was surprised to not see narcotics on the list as one of the biggies. For me, it's methadone, which I take for back pain. It is either causing or aggravating my sleep apnea with centrals and hypoventilation.

I know, I know, why not just stop taking the methadone? I've thought about that and before methodone, well I couldn't sleep because of back pain. Can't focus at work because of back pain. Can't sit for long periods. Can't stand for long periods. Don't want to do anything because of back pain. When that pain radiates, my life revolves around it, and that was pretty much daily.

So, after years of trying anti-inflammatories, other narcotics like oxycontin and morphine, muscle relaxants such as flexoril (which after a couple of weeks was having a dramatic affect on my moods), and OTC's, I finally heard about methadone. It's cheap and it is a wonder drug for 90% of my back pain.

BUT, it's either causing or aggravating my apnea. So, it's been difficult trying to decide whether to give up the methadone and live with the back pain or continue as is.

Yes Pugsy, I agree. There could be any number of reasons not to feel rested even with "good numbers" and that's kind of my point. Getting the apnea under control may be only part of the solution, although a very important part. Once that's done, we can start to look elsewhere for the rest of the solution. The idea is not to give up just because we don't feel as good as we think we should.
Ameriken, I'm sure narcotics are "on the list". Probably the same as "benzodiazepines and sedatives" I mentioned. Once I got into it, I found the list to be far to long to try to included everything. Just wanted to give folks something to think about and maybe take a look at and research whatever meds they were taking.
Jay

For me it was a beta blocker, I got a lot better after I got that changed (not great, but much better!)

Jay Aitchsee wrote:There could be any number of reasons not to feel rested even with "good numbers" and that's kind of my point. Getting the apnea under control may be only part of the solution, although a very important part. Once that's done, we can start to look elsewhere for the rest of the solution. The idea is not to give up just because we don't feel as good as we think we should.

Yep, I agree. I added my comments so that this thread has even more information in it and the next time someone complains about not feeling so good I can point them to this thread instead of giving them my usual sermon about other factors affecting how we sleep. Save my fingers from typing so much. I had been thinking of doing a thread like this for some time but just had not got around to it. You gave me a perfect chance.

My usual sermon goes something like this..
First we have to make sure the therapy is optimal. We use software to see if there is anything on the reports that might be affecting how we sleep and feel the next day. If therapy seems optimal and we have good numbers then we start looking at other possible factors that can impact how we feel. Meds, pain, hours of sleep, insomnia, fragmented sleep, bed comfort, mask issues, general health issues....

Now I can just point to this thread instead of typing the whole sermon. There is more information here about meds that you have done and the other comments will be of benefit. Hope you don't mind. I just wanted to sort of put all this in one spot for people to see. Newbies get bombarded with so much information I wanted to make it a bit easier.

Wake promoting meds also can mess with sleep..depending on dosage and half life they can delay sleep, REM and mess with the normal stages of sleep.

Pugsy, I sure don't mind your comments, and they were appropriate for Pollyanna40. Anything we can do to help folks stay with the therapy and eventually feel better is the goal. BTW Pollyanna, how do you know you're getting "good deep sleep"? Do you have a Zeo?

As far as drugs go, it appears that a great many carry the possibility of disturbed sleep. I think some of the most insidious are those prescribed as sleep aids.

Jay

Jay Aitchsee wrote:As far as drugs go, it appears that a great many carry the possibility of disturbed sleep. I think some of the most insidious are those prescribed as sleep aids.

Drugs probably cause a lot of problems with how we feel and people done realize it.
Melatonin often suggested here gave me really bad vertigo. I was thinking what the heck when it started about 30 minutes after I took it trying to help my fragmented sleep. Then I looked at the long list of side effects. Yep...vertigo or dizziness. So no Melatonin for me. I took a small dose too.

Pain is my big culprit in how come I don't feel my good numbers. Pain from bad back and pelvis. Hurts so bad that when I move in bed it wakes me up even with sleep aids trying to sleep through the pain. Wake up 20 times a night and I would feel like total crap. A new bed helped greatly but not completely. So with doctor's help we are exploring meds with low impact on next day feeling that help me sleep through the pain. I have had to make compromises. While some meds may have a bit of a hangover fog the next morning.. it is better than waking up 20 times during the night.

Don't know if you remembered back in June when I broke my wrist. Bad break and had to have it surgically repaired with some pins. Hurt really bad...I took some Percocet at night because of the pain. Well everyone says don't take opiates because it makes the OSA worse... well a person has to sleep and if pain is really bad there is no sleep. I watched my reports when I was taking the Percocet. My APAP pressures varied a little more than normal but not hugely so and my AHI went up maybe 1 to 1.5 while on that med. So it was an acceptable compromise.

I would prefer not to take any meds because I believe that most will mess with sleep architecture a bit but I need sleep to even have sleep architecture. No meds means frequent wake ups for me which for sure means feeling crappy the next day because I haven't had any chance to develop any semblance of a normal sleep architecture. While I might not feel on top of the world...I at least don't feel like the world is sitting on me.

The key is education and self awareness. Don't just pop a pill without investigating the pill to see just what it might do or what affect it might have on how we feel the next day or our sleep architecture.

Tramadol (Ultram) is a pain med that is not an opiate. It does a good job. It comes with a "may cause drowsiness" sticker. If one goes to the side effects page insomnia is listed...it wires me up something fierce. So I can't take it at bed time. Others it may knock them out. I wish it would cause drowsiness.. So I take other meds at bedtime. I rotate their use so I don't become dependent on any one med just as a precaution.

Hi Jay!! the hospital told me all looks good on Card,even though i dont feel it,our National Health service, the clinic check for u and im not allowed to mess with machine,but the nurse shows and tells me everything,i do not check my own card,they do,iv been under them for about 4mths now!! at first i saw them every 2wks,now its gone to every 3mths,so i have a long wait for my next appointment,but i can phone up and see them anytime im not happy!! from wot iv read totally different to how u lot on ere do it, i dont pay for anything as our tax's pay for our National Health care! Long winded answer but My Nurse said alls well !!

pollyanna40 wrote:My Nurse said alls well

Did you get copies of your data reports? I would want to see with my own eyes. Especially if I wasn't feeling as good as I hoped. The machine you are showing in your Profile is a full data machine. There is nothing stopping you from seeing with your own eyes. No one says you have to change anything...just look. Pulling that SD card and using the software doesn't mean you have to change anything.

Jay, my numbers are lousy- AHI usually in the high teens. My doc is convinced it is because of all the meds I take and I have become to feel he's right.

Poly, what drew my comment was the fact that you said you were getting deep sleep. Deep sleep is generally considered to be stage 3/4 sleep, also known as delta, or slow wave sleep. Now, sleep stages are really difficult to determine without an EEG. So, here's the thing. You could have great respiratory numbers and still not be obtaining refreshing sleep because your sleep architecture is abnormal. That is to say, the amounts of REM and Deep sleep you're getting are not satisfactory. Even though some people are pretty adept at reading cpap data and can make a good guess as to sleep stage, the only way I know to determine for sure what your sleep architecture looks like is by PSG which includes an EEG. I use a Zeo which is a personal consumer device costing about $200 USD to track my sleep stages. I doubt it's as accurate as a PSG EEG, but it gives me an objective, repeatable measure that helps me determine the effectiveness of treatment.
Jay

Mary, why are you using your machine as straight CPAP? Maybe, in the auto mode it would be more effective? Just a thought.
Jay

So true! I was hospitalized for severe afib in November and put on meds for that. I went on bipap in December and didn't feel good for several months. The Dr. kept telling me to "give it time". My stats looked good, my blood pressure was fine, my 02 was good. People recover from heart surgery faster than I was from afib and sleep apnea!

I finally got tired of not feeling well. In April, I insisted they pull blood work again and check meds, deficiencies, etc. They argued that they had just done that in December but I persisted they do it again. It turns out that a med that I have been on since 1994 had elevated to toxic levels because of the new heart med they started me on in November. This was a possible side effect that I didn't know about and they ignored. After reducing that med, I feel great now!