Untreatable OSA?

[joeljjk11]

So I take a medication that is sublingual and dissolves under my tongue. This medication causes my throat and tongue to almost go numb at night after I take it.

I have been using my CPAP machine since early April and have not been able to get my AHI down to a reasonable level, it is always over 5. Like last night it was 10. I have tried different masks (Airfit F10, Airfit N10, Nuance Nasal pillows) and have also adjusted the minimum pressure up and down to try to see if this would help. Nothing has been able to lower my AHI to a 'normal' level. I have basically tried everything.

Is it possible that this medication is causing my OSA to be untreatable? I have taken everyone's suggestions over the past few months and adjusted my machine but I haven't had any luck. Any more suggestions? Could I try a straight CPAP pressure instead of APAP? I am getting very frustrated with this.

[SockPuppet]

Is it possible that this medication is causing my OSA to be untreatable?

Please state what medicine you are taking. This will help get reasonable answers.

have not been able to get my AHI down to a reasonable level, it is always over 5.

Are you using Sleepyhead to monitor the effectiveness of your CPAP therapy?

[joeljjk11]

I am taking a newer psych med called Saphris. There have been nights where I accidentally forgot to take the med and my AHI was only around 4. So I know the medication is basically causing my sleep apnea but my doctor doesn't believe me and wants to keep me on it.


I have used Sleepyhead before and posted screenshots on the forum. People have suggested what to do based off of the info but nothing has worked.

[Hang Fire]

This medication (Saphris) causes my throat and tongue to almost go numb at night after I take it.

Buddy, you need to be discussing this with your doctor instead of on an internet forum.

Tardive dyskinesia (TD): Tell your healthcare provider if you cannot control the movements of your face, tongue, or other body parts. These could be signs of a serious and sometimes permanent side effect called TD. TD may not go away, even if you stop taking SAPHRIS. TD may also start after you stop taking SAPHRIS.

http://www.saphris.com/

[Pugsy]

What was your AHI during the diagnostic sleep study without cpap?
I assume your AHI is still primarily obstructive in nature (OAs and hyponeas)?
When commenting on elevated AHI it is really helpful if we know the event category breakdown.

[joeljjk11]

I have been taking the medication for over 5 years and I have been seeing my doctor for over 10, so I have definitely discussed these things with my doctor. You can't go by all of the side effects that medications cause or you would never take anything that is prescribed to you.

I am just trying to figure out how to treat my OSA and want to know if anyone else has run into problems treating it.

[joeljjk11]

What was your AHI during the diagnostic sleep study without cpap?
I assume your AHI is still primarily obstructive in nature (OAs and hyponeas)?
When commenting on elevated AHI it is really helpful if we know the event category breakdown.

I am honestly not sure what my AHI was during my sleep study. I know it was within the 'moderate' OSA range. I believe it was around 15-20. I never received any paperwork or anything, the doctor left a voicemail on my phone last year regarding it but I no longer have this voicemail.

My AHI is mostly obstructive with a very small amount of Central.

[Pugsy]

The starting minimum is the most critical pressure setting when dealing with obstructive in nature events.
You say you have gone up and down with that setting. Why go down?
Can you post and image of the statistics page from SleepyHead and make sure to include the part at the bottom where it shows the changes in the settings?
Any reduction in AHI is an improvement over without cpap. Might not be optimal but just cutting it in half is better than nothing.

If the medication is the primary factor for making the OSA more difficult to treat ...it's just more difficult and not impossible. If not taking the medication is not possible then you simply have to keep adjusting that minimum pressure until the airway can be held open better. You may just need a lot more minimum for some reason or other.
Sleeping position and REM stage sleep will also play a factor in pressure needs.

What is the highest minimum you have tried and what were the results?
It would be helpful if we could see some reports at the highest minimum.
If you have those reports posted in another thread then it would be helpful if you would link to those posts or post the images again here.
Normally I would have time to go back a read your prior threads but I don't have that time right now.

[joeljjk11]

The starting minimum is the most critical pressure setting when dealing with obstructive in nature events.
You say you have gone up and down with that setting. Why go down?
Can you post and image of the statistics page from SleepyHead and make sure to include the part at the bottom where it shows the changes in the settings?
Any reduction in AHI is an improvement over without cpap. Might not be optimal but just cutting it in half is better than nothing.

If the medication is the primary factor for making the OSA more difficult to treat ...it's just more difficult and not impossible. If not taking the medication is not possible then you simply have to keep adjusting that minimum pressure until the airway can be held open better. You may just need a lot more minimum for some reason or other.
Sleeping position and REM stage sleep will also play a factor in pressure needs.

What is the highest minimum you have tried and what were the results?
It would be helpful if we could see some reports at the highest minimum.
If you have those reports posted in another thread then it would be helpful if you would link to those posts or post the images again here.
Normally I would have time to go back a read your prior threads but I don't have that time right now.

I am at work right now so I will post some Sleepyhead stats when I get home.

My minimum is currently 14 with max of 19 and I am using the Airfit F10. I have tried minimums of 15 with max 20 with my nasal pillows. When I switched to the F10 I was using min 12 with max 19. I will try raising the minimum even more, what should it be though? 16? Everytime I have raised the minimums it has not really helped the AHI much and just caused me to be very gassy in the morning from the air pressure.

[Pugsy]

A good many people find that more pressure is needed with a full face mask than with a nasal pillow mask so I would suggest using the nasal pillow mask if at all possible.

I haven't seen enough reports with the highest minimum to get a feel for what might be needed but if 14 isn't getting the job done then we go higher...

The aerophagia issues do make it difficult...are you using EPR? If so at what setting?
If you only need higher pressures part of the night I wouldn't go to cpap mode because you will need to use higher pressures all night instead of part of the night and that will likely make the aerophagia issues worse.

[ChicagoGranny]

So I know the medication is basically causing my sleep apnea but my doctor doesn't believe me and wants to keep me on it.

What about getting a recommendation from a trusted friend and seeing another doctor for a second opinion on the drug you are taking?

You could also schedule a visit with the sleep doc to review the situation. He could write a letter to the prescribing doc explaining the situation.

my doctor doesn't believe me and wants to keep me on it.

Some doctors can be a&%holes or worse. If I can't get them on the right track immediately, I put them on my Permanent S&%t List and find another doctor.

Good luck,

[yaconsult]

Please contact your doctor's office and ask them to send you a copy of your sleep study results - you are entitled to it and it contains very useful information. When I called the sleep study center they were happy to print out a copy and mail it to me.

Regarding drugs affecting cpap therapy, I would ask both my sleep doctor and my primary physician to investigate, if necessary, any possible interaction between the medication you are taking and cpap therapy.

Also, note that some people take longer than others to get the full benefits of cpap therapy. People have even seen a gradual improvement over many months and in some cases even a year or more. Everyone hopes for immediate relief, but unfortunately it takes more time for some people.

How rested are you feeling now compared to before you started cpap? That's much more important than the AHI numbers.

If you are correct that your diagnosis was moderate: Moderate: AHI ≥ 15, but < 30 per hour. But please get a copy of your sleep study results so that you know exactly what your issues were. When you call them for it, would be a good time to find out the best way to communicate with your doctors to get your questions answered. My clinic has an online system that lets me send and receive messages from all my doctors. In other places, it might require a phone call or scheduling a meeting with the doctor. Some facilities have advice nurses that will go off and consult with doctors and get answers for you and call you back.

Once you confirm whether or not there is an issue between your medications and cpap, it will be one more thing that you can cross off your list.

In other threads you've posted graphs showing pressures hitting 19 so I would also want to check with the sleep doctor to see if perhaps a bilevel or other more specialized machine might be required in your case. Your sleep doctor can look at your data and advise you on this. Remember that the sleep study is only a snapshot of a single night of sleep. But you now have done your own mini-sleep study every night and have all that useful data on your memory card and in sleepyhead.

[OSAHell]

Hi joeljjk11,

You should call your sleep doc and ask for the FULL report of your sleep study not just a summary or "over the phone" numbers. I'll definetly look at your answers to the questions here and your "Statistics page" when you'll post it. It would also be interesting to have the wrost and best night's graphs of the past week or so (full Sleepyhead window). It's been suggeste to me at some point in the past that I might be an "Untreatable OSA patient"... Now, with the right machine (and a lot of research by me), my apnea problem is well under control but I'm still in "recovery" and it might be some time before I get where I want. I fall in those noticing little, but steady, improvement over weeks not days...

Good luck

[HoseCrusher]

If you took that particular medication early in the morning, you may not be able to communicate well with your family but the effects may wear off by the time you go to bed...

[joeljjk11]

Haha yeah I have tried that and it essentially turns me into a non-functioning zombie. It also makes me extremely tired, like to the point that I have to sleep immediately.