New and worried about driving licence

[Data]

I have recently been diagnosed with severe sleep apnoea had my machine (I believe it is APAP) for a month now. The first night I couldn't manage it, the second night I struggled but persisted, and from then on I have used it every night. It has made a difference to my levels of daytime tiredness. Our curtains are not that thick, and I tend to wake up at dawn (around 5am), at that point I take the mask off and sleep for a couple of hours without it.

A week after my diagnosis, I sent form SL1 to the DVLA, but I have not heard back from them at all. Is that normal?

I have suffered from mental health problems for a long time and recently they have been improving a lot, my counselling has been working. Because of those problems, I developed issues with binge eating and heavy drinking. But in the last month I have turned my life around. I have started going to a circuit training class once a week, and I have stopped drinking completely and gone on a diet; I am losing about 1kg (2 pounds) a week. My hope is that if I lose a bit of weight, am teetotal and have improved fitness, the sleep apnoea will improve.
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Also, I am waiting for a consultation with an ENT surgeon to see if I can have my tonsils taken out. Apparently they are very large and are obstructing my airway.

I no longer believe I need the sedatives that I was taking. These are appetite stimulants, which make it difficult to diet. Also, I have heard any sedative can make sleep apnoea worse. Lately I was taking 50mg of quetiapine (Seroquel) a night. I managed to get that down to 25mg with no real problems. However, I tried cutting it out and I found I lay awake for hours so for the last week I have been taking half a 25mg tablet a night (about 12.5mg).

Since I have reduced to half a tablet, I've noticed it is harder to get to sleep. The last week has been particularly bad, and today I have woken up still feeling tired. I may be getting some withdrawal symptoms from the quetiapine. Also, the mask is uncomfortable. It leaks, particularly around the bridge of my nose. It rides up my face, and ends up near my eyes. I can't get into a good position in bed; I find it hard to sleep on my back, and when I lie on my side on the pillow, the pressure from the pillow tends to make the leak worse. I have tried pulling the mask off my face temporarily and letting the cushion re-adjust before putting it back on; I have tried adjusting the tightness of the straps; I have tried pulling the straps down to a different position on my head, but it seems to make little difference.

I have probably had sleep apnoea for years. I have not had a car accident for a long time. I never fall asleep in the day and am a careful driver. I did an online sleepiness test - I think it is based on the Epworth test (?), and I scored 3 out of 24 !

I work from home as a full-time student at the moment, and I am due to submit my thesis for a PhD in artificial intelligence on 1st October 2012. Then, I will be looking for work nationwide as there is little chance of me finding anything in my home town. I need my driving licence! Its REALLY tough finding work out there at the moment, without having a handicap such as having to use public transport.

I am wondering what to do. Should I increase my sedatives again, perhaps go back up to 25mg, because that might help me sleep better at night? Or maybe the insomnia is a temporary thing whilst I am reducing the dose of the tablets? Is it perhaps that I need some tuition to help with the mask fitting, or perhaps a different mask? Maybe it doesn't fit well on me?

The thing that bothers me is that they will analyse the results of the machine and find out that my usage is too low, and my licence will be revoked as a result - making me unemployable. That seems a bit harsh to me because I am complying with the treatment, and whatever the problem is - sedative withdrawal, poorly fitting mask - I deserve a chance to get it sorted.

[Julie]

Hi - sorry to hear you're having a hard time, but wait (particularly) for Roby Sue to reply as she's had lots of experience with insomnia and can give you good advice. I do feel that your removing the mask a couple of hours prior to getting up (and sleeping for that time) is counter productive as you allow apneas to occur. Of course you do need to get some sleep though. I also feel you need to work with your doctor about the Seroquel to find the right balance, preferably not having to use anything, but using the right medication (there are many out there!) if you do take something... it's important not to play with dosages on your own.

Also, you may or may not have the mask on too tight, which can actually create new (micro) leaks where there were none previously, and a good fit is te best answer, but you may end up going through a few different masks to find that...

Can you click on User Ctl panel under the main logo on the left, then on Profile, and fill in the full name and model #'s of your machine and mask, plus (if you can) what pressures you were prescribed and anything else you think might be relevant, so we can all know right away when seeing a post from you what's what and hopefully be better able to help.

[49er]

Hi Data,

A week after my diagnosis, I sent form SL1 to the DVLA, but I have not heard back from them at all. Is that normal?

Is this a form for your driver's license?

I no longer believe I need the sedatives that I was taking. These are appetite stimulants, which make it difficult to diet. Also, I have heard any sedative can make sleep apnoea worse. Lately I was taking 50mg of quetiapine (Seroquel) a night. I managed to get that down to 25mg with no real problems. However, I tried cutting it out and I found I lay awake for hours so for the last week I have been taking half a 25mg tablet a night (about 12.5mg).

Since I have reduced to half a tablet, I've noticed it is harder to get to sleep. The last week has been particularly bad, and today I have woken up still feeling tired. I may be getting some withdrawal symptoms from the quetiapine.

You might need to taper it alot more slowly. I say this as someone who got off of 4 psych meds.

Please visit this board to see there is information on slowly tapering this drug:

http://survivingantidepressants.org/index.php?/index

Even though it is an AD withdrawal board, if I remember correctly, someone had information on tapering off of an antipsychotic.

If I am wrong, PM me and I will see what I can about finding information for you.

Also, the mask is uncomfortable. It leaks, particularly around the bridge of my nose. It rides up my face, and ends up near my eyes. I can't get into a good position in bed; I find it hard to sleep on my back, and when I lie on my side on the pillow, the pressure from the pillow tends to make the leak worse. I have tried pulling the mask off my face temporarily and letting the cushion re-adjust before putting it back on; I have tried adjusting the tightness of the straps; I have tried pulling the straps down to a different position on my head, but it seems to make little difference.

Please fill out an equipment profile so we know what mask you are using and can help. You might have to simply try another mask. Many people have to go through several before finding the right one.

I am wondering what to do. Should I increase my sedatives again, perhaps go back up to 25mg, because that might help me sleep better at night? Or maybe the insomnia is a temporary thing whilst I am reducing the dose of the tablets? Is it perhaps that I need some tuition to help with the mask fitting, or perhaps a different mask? Maybe it doesn't fit well on me?

If you are interested in getting off of meds, as I mentioned previously, I would slow your taper down considerably. You might need to taper as slowly as 5% of current dose every 4 to 6 weeks since many people find it very hard to get off of APs. I am not a doctor but it seems the amateurs know more about tapering than many doctors do.

The thing that bothers me is that they will analyse the results of the machine and find out that my usage is too low, and my licence will be revoked as a result - making me unemployable. That seems a bit harsh to me because I am complying with the treatment, and whatever the problem is - sedative withdrawal, poorly fitting mask - I deserve a chance to get it sorted.

Who are you referring to? The DMV? Sorry if I am missing something.

49er

[49er]

Data,

I wanted to add a bit of clarification to my previous post regarding my psych med taper.

The toughest times I went through is when I tapered off of Doxepin and Remeron which were sleep meds. At one point, I had to updose the Doxepin even though I was tapering very slowly.

Unfortunately, that didn't really help and I simply had to just tough it out.

Of course, you should work with your doctor but I am concerned that most doctors don't understand the principles of tapering as many of them taper patients way too quickly. The reason for a slow taper, particularly with an antipsychotic is that your body needs time to adjust to having lower amounts of medicine as it has made number changed throughout your whole system.

Cutting a dose too fast is like putting the brakes on the car going 60 miles an hour.

Anyway, good luck and let me know if you have further questions.

49er

[Data]

Thanks for the replies so far.

Julie - you might be right about taking the mask off at dawn. I wake up and typically the pressure has increased and its blowing all over my face and the room is light since it is summer. However, maybe I have to work through this issue. Perhaps if I reset the machine, to bring the pressure down, I might be able to get back to sleep again - I think I'll try that tonight (tomorrow!).

I have filled out my profile as best I can but I can't find the correct option for my mask (Quattro FX Small - not a full face mask). I don't know what the software is.

I understand what you mean about working with my doctor, but the psychiatrist has discharged me so its just my general practitioner now. And the prescription says "take up to 6 tablets a day" - which is 150mg, so they are just leaving it up to me to manage the dose myself.

49er - yes the SL1 is a driving licence form, for the DVLA (Driver and Vehicle Licencing Agency), which is the UK's equivalent of your DMV I think.

I am going to struggle to taper it more slowly as 25mg is the lowest dose of tablet that they manufacture, and they don't make syrups - I've checked.

Maybe I should see my doctor but my concern is that if he is over-zealous and says not to drive, then that will invalidate my car insurance.

[49er]

r it more slowly as 25mg is the lowest dose of tablet that they manufacture, and they don't make syrups - I've checked.[quote][/quote]

Hi Data,

In the US, there are compound pharmacies that make the unusual doses you can't get at your local drug store. Would this be an option in the UK or did you cover that when you checked about syrups?

Another possibility - Check to see if Seroquel can be crushed. If it can, then I will explain the next steps.

Thanks for clarifying on the driving issue. Tough issue.

49er

[49er]

Data,

Is this doctor near you by any chance as he is supposedly helpful with psych med tapering?

United Kingdom

Robert Lefever, MA, MD, B Chir., South Kensington, London

http://survivingantidepressants.org/ind ... r-clinics/

[Data]

I guess the problem is that I'm not sure if the difficulty sleeping is due to the mask, or the (lack of) quetiapine.

South Kensington is 150 miles from me, so he isn't near. And he would probably be quite expensive - I get my treatment free locally from the NHS (National Health Service).

Another thing - I was told by the hospital to rinse out the filter on the machine periodically, but I forgot . I have just done that now, and its drying upstairs. I'm not sure if that will make a difference though.

[49er]

I guess the problem is that I'm not sure if the difficulty sleeping is due to the mask, or the (lack of) quetiapine.

Or it could be both:) But you make a good point.

South Kensington is 150 miles from me, so he isn't near. And he would probably be quite expensive - I get my treatment free locally from the NHS (National Health Service).

That is too bad since it is hard to find doctors who are knowledgeable about withdrawal issues. Hopefully, you discover the mask is the problem and not the med.

Good luck!

49er

[SleepDepraved2]

For the mask, you can buy liners from Pad-A-Cheek and that can help with the leaks. You can also get a CPAP pillow that helps with side sleeping issues and leaks. Finally, get a hose management device to reduce the drag from the hose on your mask, that will also help with leaks.

[retrodave15]

The one comment I have is Seroquel is an anti psychotic med that has been used off label as a sedative. For some people - like me- it works very well to help me sleep. I have found that seroquel works by calming the mind and stopping my racing thoughts so I can actually sleep. Since seroquel is not a typical sedative, according to my doctor, it does not cause respiratory depression and actual gets to the cause of my insomnia - racing thoughts that kept me awake. It had no effect at 25 MG, and was only effective at 50 MG for me.

If you want to come off seroquel - you must do it very slowly, as long as you do not have the extended release formula (XR) you can split the pills with a pill splitter.

[Data]

SleepDepraved2 - I didn't realise you could get these things, I will discuss them at the hospital when I have my next follow up in 8 days, thanks.

retrodave15 - interesting, thanks. Maybe quetiapine does not make my apnoea worse after all. As I said in my original post, I am using a pill splitter. I think I'll carry on with 1/2 tablet for a while, just to let my body get used to the lower dose, before I come off it altogether.

[Julie]

Read the link I gave you... it's your body and mind at stake!

[avi123]

You might be better off without a driving license, b/c if you get involved in an accident and the other person involved see your public post above then you might spend lots of time in prison. Would it be better?

[xenablue]

How would anyone know who the OP is if there's no personal information linking to the forum?

xena