Dr claims death caused by lunesta&poor fit

[MiLady56]

I love my CPAP. but, new GP says that poor fit and Lunesta can result in death. He is refusing to prescribe Lunesta unless I go to referred sleep center.
I fear the costs of a sleep center. Checking my fit is one thing, but from what I read, they start the monitoring and the visits/costs increase.
Things have changed since 6 yrs ago when I had sleep study. I need some info. what is reasonable treatment to expect? Questions I need to ask. I don't want to get fleeced.

[SGearhart]

I'd ask to see his data on poor fitting CPAPs and Lunesta. . . but that's just me.

[Darth Lady]

Yeah, and how does s/he even know you have poor mask fit? What might Lunesta do - stop you from breathing? In that case, I wouldn't want to take it even if my mask fit perfectly. Was Lunesta and mask fit the only reason given for why you need a new sleep study? Is this doctor affiliated with the lab in question, mayhap?

And if mask fit is so poor that you're effectively untreated, then you wouldn't need Lunesta to suffer complications from that.

If you have a DME, they should be able to set up a mask fitting if you are concerned about that. Or you can find a DME that works with your insurance (I'm hoping you are fortunate enough to have decent insurance, but the way things are these days... ?) and get a mask fitting, although you'd need cooperation from some doctor or other to actually get a new mask.

[cpapernewbie]

suggest that you check your data. Do you really have big leaks. How is your AHI? etc etc
One way to get better opinion here is by completing your profile: what is your CPAP device, mask etc etc

[herefishy]

I hate to be suspicious, but does your doc have an interest in the referred sleep center? Should you ask him about going to a DME and see if you get the same answer?

[JDS74]

Lunesta is a central nervous system (CNS) depressant so his concern may be onset of central apneas if using the drug. If your mask doesn't fit well and you develop severe central apneic episodes that might be troublesome.

Here are some cautions about the drug:
alcohol use
avoid abrupt withdrawal (prolonged use)
caution if CNS depressant use
caution in elderly or debilitated pts
caution if hepatic impairment, severe
caution if impaired respiratory fxn
caution if depression
caution if psychiatric disorder
caution if alcohol or drug abuse hx

[MiLady56]

(Not sure if I am doing this right)
Thx for info. DME means the store that sells the equipmt, right? Yeah, original sleep study done by local hospital dr. They gave me a list. I didn't ask questions(stupid)....I truthfully have been "making do" with mask scripts from dr friends. Decided to get under care of 1 GP, now this....I agree with discrepancies cited here. B'ght new mask online w/out script. Can DME check fit?

[Julie]

You should do that - lying down with pillows (if you normally use them). You shouldn't be overtightening the mask (it won't inflate otherwise) but it should not be sliding off either. You're going to be the best judge of fit and leaks (are you not using software?) SleepyHead is free to download from this site.

[ChicagoGranny]

Your doctor is right to issue the warning and refuse to prescribe Lunesta. Kudos to him! Many doctors would just give you a prescription to get you out of the office so it is on to the next appointment.

Why do you need Lunesta anyway? The two big likelihoods are ineffective CPAP therapy and poor sleep hygiene.

As far as sleep hygiene:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life

And then as for effectiveness of CPAP therapy, start using software to monitor your breathing at night. You can check the leak line daily to make sure your mask is fitted properly. You can check other daily details in the reports to make sure your CPAP therapy is effective. You can post here with questions about interpretation of the reports and help with machine settings and mask fit. All of the regulars here do it this way and would not have it any other way.

You can avoid the cost of the mask fitting sessions and copays for Lunesta if you take charge of your own therapy.

If you need help, just ask here!

[MiLady56]

...am happier! firstly, emotional stress is problem. Spouse is OCD. Lunesta seems to help with restless legs, but there are other drugs for that. I read DME in glossary and am thinking I could research. Negotiate with dr re: mask fit and monitoring on my own. Thx

[Nick Danger]

So far the advice about sleep hygiene seems a lot like the advice to drink 8 glasses of water a day. It makes sense that it should work. Everybody thinks it's a good idea. However, the data are not really supporting the advice. This 2014 literature review (The role of sleep hygiene in promoting public health: A review of empirical evidence by Leah A. Irish, Christopher E. Kline, Heather E. Gunn, Daniel J. Buysse, Martica H. Hall) found no clear effect of sleep hygiene - it would have been more interesting if the review had been a meta-analysis.

[Boyce]

This 2014 literature review (The role of sleep hygiene in promoting public health: A review of empirical evidence by Leah A. Irish, Christopher E. Kline, Heather E. Gunn, Daniel J. Buysse, Martica H. Hall)

Do you have full access to the report? A subscription is needed and since I will not pay for, I can only see the report summary. Maybe you saw something important that I did not see?

However, the data are not really supporting the advice.

Well the summary says, in part,

epidemiologic and experimental research generally supported an association between individual sleep hygiene recommendations and nocturnal sleep

I consider that heavy scientific evidence for the benefits of sleep hygiene.

Now I understand a little bit about scientists and they also want evidence obtained through direct observation (Medicine calls this clinical evidence.).

Just because that clinical evidence does not yet exist, does not mean the positive epidemiologic and experimental research should be dismissed. The authors of the report you cited also don't seem to discount this heavy evidence - they only have a desire to obtain clinical evidence.

http://www.smrv-journal.com/article/S10 ... 2/fulltext

[SewTired]

I'm new here. Actually, what the doctor is telling you is not unreasonable. If your current therapy is not working and it's been four or five years since you were last evaluated,he'd be a pretty crappy doctor to just write you a prescription for a sleeping pill. You apparently have a worsening condition.

I'd call the referred sleep clinic and find out the costs with your insurance.

[edited: Fixed spelling errors caused by that danged auto-correct!]

[Sheffey]

Lunesta seems to help with restless legs, but there are other drugs for that.

You are right about other drugs. I've never heard of Lunesta being prescribed (appropriately) for RLS.

There is a good drug protocol for selecting drugs to treat RLS. In my experience, GPs don't always know about it or follow it and it is best to consult your sleep doc for treatment of RLS.

Now for someone who has sleep apnea and RLS, it becomes doubly important to follow Granny's recommendations for sleep hygiene.

Negotiate with dr re: mask fit and monitoring on my own.

Ha! If you start talking to a GP about software of your own to monitor your therapy and mask fit, he most likely will not have a clue about what your are saying.

Just download the software and get started on your own. Read Pugsy's first post here - viewtopic.php?f=1&t=88983&start=0

Let us know what model machine you have and someone can tell you whether it is "data capable" or just a "dumb brick".

As far as sleep hygiene:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life

"Someday science will catch up with what you are saying."

[Samaniego]

I love my CPAP. but, new GP says that poor fit and Lunesta can result in death. He is refusing to prescribe Lunesta unless I go to referred sleep center.
I fear the costs of a sleep center. Checking my fit is one thing, but from what I read, they start the monitoring and the visits/costs increase.
Things have changed since 6 yrs ago when I had sleep study. I need some info. what is reasonable treatment to expect? Questions I need to ask. I don't want to get fleeced.

Post your machine manufacturer and model number. You find on the tab on the bottom of machine.

We should tell you it works with software before you download software. If it is old machine, it may be a brick. Even some new machines are brick.