CPAP and Ambien

[amos]

Greg,

To answer you question about taking Ambien and the use of cpap.

No, I would never take Ambien without using the cpap. This would only increase your apneas.

Yes, do take Ambien with the cpap. The cpap should compensate for any increase in apneas.

amos

[Cpapkid]

I'm just going to jump in here and state my layman's opinion--no one should be offering prescription advice to anyone unless they're a qualified MD. This person's doctor felt his patient needed Ambien. If this advice is going to be ignored because of some amateur's uneducated opinon, why are they paying a doctor? Why not go down to the hardware store and ask the clerk his opinion? I think this forum is great as long as people discuss their CPAP experience--not so great when uneducated opinons are offered on serious subjects other than for what this forum is intended. JMHO

[roster]

I'm just going to jump in here and state my layman's opinion--no one should be offering prescription advice to anyone unless they're a qualified MD. This person's doctor felt his patient needed Ambien. If this advice is going to be ignored because of some amateur's uneducated opinon, why are they paying a doctor? Why not go down to the hardware store and ask the clerk his opinion? I think this forum is great as long as people discuss their CPAP experience--not so great when uneducated opinons are offered on serious subjects other than for what this forum is intended. JMHO

So think we are uneducated about drugs and procedures? How much does the typical doctor know about Ambien? Probably only what the marketing rep from Sanofi-Aventis told him. Do you think the typical doctor has read the product literature that comes with Ambien? Very few have, but many of us have read this and much more.

Have fun rolling your eyes. Most of us here know we are responsible for our own health. Also, many of us have multiple horror stories about incorrect diagnoses and improper treatments prescribed by doctors.

[old64mb]

Medical literature on the non-benzodiazepines (Ambien, Lunesta, Sonata, and Rozerem) and OSA:

...you will experience even longer and stronger apneas...

http://findarticles.com/p/articles/mi_h ... _n29448018 is a quick review of the literature on this subject, and http://www.medscape.com/medline/abstract/16944674 addresses this with Ambien directly.

There was one 20 year old study cited in the first link that raised the possibility that AHI and desat might be increased under the influence of Ambien if you were snoring, but it wasn't a large enough delta versus placebo to be considered statistically significant. That's been the only study that showed this even as a remote possibility, and it's worth noting that the participants were given 20 mgs, or 2x the current FDA approved dosage. The more recent study showed no evidence of increased AHI or desats.

Studies of the other non-benzos at prescribed dosages have not shown any difference in AHI or desats.

Ambien wrecks normal sleep architecture by reducing the amount of REM sleep.

There's been one study on humans - http://www.mdconsult.com/das/citation/b ... html?issn= - that suggests that a higher-than-recommended dosage of 15 mg of Ambien decreases REM sleep after a long period of consecutive usage (14+ days.) It's important to note that on the FDA approved dosage of 10 mg, this effect didn't show up, nor did it show up under normal usage (3-5 days).

There have been a couple studies on rats - http://cat.inist.fr/?aModele=afficheN&cpsidt=15718621 and http://www.sciencedirect.com/science?_o ... f2fadc8153 - that suggested Ambien decreased REM sleep but increased slow wave sleep (deep sleep). No information on dosages, and I have been told by my sleep doctor (who still does active clinical research) that she doesn't bother reading the rat sleep studies anymore since they've not translated well to humans.

There was also one on guinea pigs comparing Lunesta and Ambien that showed Ambien at normal to high doses didn't do much of anything, where Lunesta at high to very high doses did increase both SWS and latency to REM - http://www.websciences.org/cftemplate/N ... D=20082311.

The rest of the literature suggests that about the only truly consistent finding for Ambien is that it doesn't do much to sleep architecture besides decreasing sleep latency and improving sleep efficiency. Someone was nice enough to put out a bunch of abstracts of numerous studies here: http://patrifriedman.com/writing/journa ... pidem.html, and someone else pointed out some older studies here http://www.sleepnet.com/tech7/messages/1015.html that pretty much agree on that.

I always skipped the ambien on Friday and Saturday nights (no work the next day) to avoid the potentially bad rebound effects if I tried to stop

Probably a wise thing. There have been two studies on Lunesta that suggest it's safe for continuous use over 6 months, but they're sponsored by the manufacturer. (Thanks, I'll pass.)

The one on Ambien - http://www.mdconsult.com/das/citation/b ... html?issn= - confirmed my own experience. If you take it for a few days, you're fine. More than that, you'll get rebound insomnia.

And to summarize all this, I found a post by a guy who does have an MD, practices sleep medicine, and who apparently has read the studies beyond those the reps have given him: http://sleepdoctor.blogspot.com/2005/12/ambien.html

Cheers.

[OldLincoln]

I'm just going to jump in here and state my layman's opinion--no one should be offering prescription advice to anyone unless they're a qualified MD. This person's doctor felt his patient needed Ambien. If this advice is going to be ignored because of some amateur's uneducated opinon, why are they paying a doctor? Why not go down to the hardware store and ask the clerk his opinion? I think this forum is great as long as people discuss their CPAP experience--not so great when uneducated opinons are offered on serious subjects other than for what this forum is intended. JMHO

Hi and welcome to the Forum. I also will jump in here and offer my opinion. I agree that only qualified people should write prescriptions - of course that leaves out a lot of MD's. The doctor wrote a script to resolve a complaint. No indication that the doctor knows much about CPAP or the combination. It is likely that the patient discussed CPAP as a factor in difficulty sleeping so did the doctor discuss it with him/her? We don't know, but the patient asked a question and many here have actual experience with the combination and are willing to share them. I don't believe anybody offered to write a prescription for an alternative drug or told them to rush to emergency did they. Haven't you ever discussed a new Rx with family when you knew they took the same one?

Look at this another way. What if somebody was prescribed a drug that was universally known in the CPAP community to be dangerous with CPAP? Should they simply shrug their collective shoulders because they aren't doctors? I certainly hope not!

While some here may be doctors, others RT's, etc., most are like that family member sharing their experiences.

[WearyOne]

I'm just going to jump in here and state my layman's opinion--no one should be offering prescription advice to anyone unless they're a qualified MD. This person's doctor felt his patient needed Ambien. If this advice is going to be ignored because of some amateur's uneducated opinon, why are they paying a doctor? Why not go down to the hardware store and ask the clerk his opinion? I think this forum is great as long as people discuss their CPAP experience--not so great when uneducated opinons are offered on serious subjects other than for what this forum is intended. JMHO

Hey, cpapkid, I'm just curious, have you never been given a prescription for something, including cpap, or wondered about an OTC drug and ask your friends or coworkers if any of them have ever taken it, maybe to see how it worked for them? Have you ever researched medications before taking them? I agree that to tell someone an unequivocal NO or YES that they should or shouldn't take a medication that a physician has subscribed probably isn't a great idea. But, to share your own experiences with a medication, or maybe what your doc has told you---I don't see any harm in that at all. And when the comment is made similar to, "In my opinion," then that's just what it is, an opinion, not a medical recommendation. Or if in doing research, you find something about a med, negative or positive, I don't see anything wrong with sharing it.

My experience with Ambien is that it doesn't work for me in lower dosages, and I don't want to try a higher one because of my son's reaction to it. Didn't work for him at a lower dose, and when he upped it, per doc's instructions, he still didn't go to sleep, but had hallucinations and felt like the bed was flying. Personally, when I have problems sleeping, I take a low dose of Ativan. When I do this, I don't notice any different in my AHI numbers. If I did, and thought I would be on it for a week or so, I would probably raise my pressure a tad while on it to compensate.

Pam (They need a smiley with a cpap mask!)

[jda1000]

I feel I've a good doctor, but one thing I've learned from a few months with OSA and 5-6 weeks of CPAP - he's a better doctor and I'm a better patient if I back him up by learning all I can.

A big part of that is learning from peers, almost everyone of the here, using CPAP and dealing with the mechanics and chemistry and psychology of it.

The rest is Google. Of course.

Of course, we must always ask ourselves: would Hunter S. Thompson take this drug?

[yorkiemum01]

I feel a bit hesitant to even comment on this topic...as I know Ambien (and other sleep aids) arent
recommended long term for anyone. But on this note, my physician advised me that my chronic
insomia was much more dangerous to my health than using ambien to allow my body to rest. I dont
drink caffiene, not lying awake stressing about life...I just simply...dont sleep. Even my initial sleep
study required a second night as I only acquired minutes of sleep in the lab, but with the aid of
ambien, was able to sleep 4 hours. Certainly, I understand the risks and dont use it every night, but
I NEED to work......and after a lifetime of inability to sleep, this medication allows me to sleep ..rather well.
Please dont judge too harshly.

[stvgrayson]

It is not clear that AMBIEN changes the architecture of sleep. Compared to the other benzodiazepines. any changes to REM sleep are minimal or not at all. Studies done have not been consistent.
Also, let me note that since my pulmonologist prescribed ambien 5 mg my (AHI) have improved significantly