OSA and ritalin

[kittystar]

Okay now I am very confused; I had sleep studies last fall and have been using a CPAP without much impressive results ever since. Having had an ongoing problem with insomnia, I went back to my sleep dr and he was not inclined to medicate me for sleep. I did use ambien for a bit, but found that the regular dose started giving me shorter periods of sleep. The sleep dr did not want to give me anything else and suggested CBT and working on the premise that I had an advanced sleep cycle problem. Being really tired of being really tired,I went back to my primary care doctor and he is convinced I have ADD and has started me on 10 mg ritalin three times a day. He tells me this will make me more alert in the daytime and when it wears off, I will "sleep like a baby" and to continue to use the CPAP. My son is ADD and the PCP states there is a very strong hereditary connection with ADD (that almost always an ADD child has an ADD parent. Interesting, since talking with my ADD son he said, you know Mom it sounds like ADD, so way surprised when the PCP arrived at this diagnosis. I just started the ritalin today and can hardly wait to see if I "crash" once it gets dark.
Any way, has anyone else had any experience with OSA and using ritalin to completely prevent any danger of napping in the daytime??

[roster]

Kitty,

Two things:

1. There are two pediatricians (if you Google you might find them) who prescribed a lot of drugs for ADD and ADHD. Short story, they eventually found out that 70% of their patients had sleep-disordered breathing. Once this was treated properly the ADD and ADHD went away.

2. You don't show the software in your equipment profile. So if you don't have the software, how do you or your doctors know your therapy is effective? I would first spend money to get the software instead of spending it on drugs. Find out if your CPAP therapy is effective before starting drugs. Drugs will not improve your CPAP therapy; software very well may.

Regards,

[twokatmew]

My old PCP gave me Ambien CR to help me sleep and Ritalin in the morning to help me get up. When I changed docs, my new PCP immediately took me off the Ritalin and after a while also the Ambien CR (which wasn't really helping anyway). She also ordered a sleep study, and sure enough, I was diagnosed with OSA....

[Kiralynx]

Any way, has anyone else had any experience with OSA and using ritalin to completely prevent any danger of napping in the daytime??

No experience with Ritalin and OSA... but some experience with ADD/ADHD. ADD/ADHDers tend to react in an anomalous fashion to stimulants. Instead of it waking you up, it's likely to put you to sleep if you are an ADD/ADHDer because Ritalin is a stimulant.

So if your doc is expecting you to "wake up" on Ritalin the way non-ADD/ADHDers do, both you and he may be disappointed.

[SaltLakeJan]

I have a history of Fibromyalgia, I had treatment from a competent doctor. He changed specialities and I found a new PCP. I had experienced fatigue for quite a while, told my new pcp, he insisted I had Chronic Fatigue. & wanted to prescribe Ritalin 20 mg. I was sure I didn't have CF because I only had fatigue as a symptom. CF has many complicated problems that accompany it. I eventually got so tired of the fatigue, I began taking Ritalin.

I took ritalin shortly after getting up. Within an hour it had picked me up until I could have run a race. Unfortunately about 2:00 p.m. I crashed. I was so exhausted I could hardily stand it.
I stayed on Ritalin until last Dec or Jan, when I decided I couldn't stand that routine. I took myself off, and about the same time I had a sleep study which diagnosed my sleep apnea.

The fatigue my (former) pcp diagnosed as Chronic Fatigue was sleep apnea.

I did not have a good experience with Ritalin.

Good luck with your decision.

Jan

[roster]

I have a history of Fibromyalgia, I had treatment from a competent doctor. He changed specialities and I found a new PCP. I had experienced fatigue for quite a while, told my new pcp, he insisted I had Chronic Fatigue. & wanted to prescribe Ritalin 20 mg. I was sure I didn't have CF because I only had fatigue as a symptom. CF has many complicated problems that accompany it. I eventually got so tired of the fatigue, I began taking Ritalin.

I took ritalin shortly after getting up. Within an hour it had picked me up until I could have run a race. Unfortunately about 2:00 p.m. I crashed. I was so exhausted I could hardily stand it.
I stayed on Ritalin until last Dec or Jan, when I decided I couldn't stand that routine. I took myself off, and about the same time I had a sleep study which diagnosed my sleep apnea.

The fatigue my (former) pcp diagnosed as Chronic Fatigue was sleep apnea.

I did not have a good experience with Ritalin.

Good luck with your decision.

Jan

This is an illustration of why I would be concerned about Ritalin for KittyStar. Jan's OSA was not being treated and Ritalin did not work well for her. Since KittyStar does not seem to monitor her therapy, her therapy may be ineffective and Ritalin would be inappropriate at this juncture.

[old64mb]

The sleep dr did not want to give me anything else and suggested CBT and working on the premise that I had an advanced sleep cycle problem.

I'd start thinking about getting a new sleep doctor, because if you do have an advanced sleep cycle problem my (limited) understanding is they'd more than likely want to see you in the lab again. In their defense they didn't just haul out a script pad and prescribe Provigil or such (which is the easy solution), but offsetting that is they don't seem to be particularly interested in seeing if your CPAP therapy is actually working before foisting you off on someone else.

Being really tired of being really tired,I went back to my primary care doctor and he is convinced I have ADD and has started me on 10 mg ritalin three times a day. He tells me this will make me more alert in the daytime and when it wears off, I will "sleep like a baby" and to continue to use the CPAP. My son is ADD and the PCP states there is a very strong hereditary connection with ADD (that almost always an ADD child has an ADD parent.)

He's right and wrong. It's been a while since I've looked at the literature but off the top of my head I think it's about a 30% chance of passing it along if it's one parent with ADHD and over 50% with two.

He's also may be right to an extent about the amphetamines helping sleep patterns, although I doubt he's aware he's right. There's one slightly obscure article which strongly suggested Concerta (basically the longer acting version of Ritalin) aided latency and REM in true ADHD patients - those without OSA - but it's not received a lot of attention.

However, if he's really convinced you might have ADHD, given your sleep doc's diagnosis of an advanced sleep cycle problem, your PCP should really should be passing you along to a psychiatrist who specializes in either sleep or ADHD rather than making the call himself. They'll know a lot more about the appropriate next step. PCPs in general don't see enough ADHD or sleep patients to really come to a conclusion on a potentially complex case like your own - they're great for maintenance and overall diagnosis, but when you get into higher order stuff like you've been having it's time to go to someone who sees a lot more patients like yourself.

[roster]

.........
I'd start thinking about getting a new sleep doctor, because if you do have an advanced sleep cycle problem my (limited) understanding is they'd more than likely want to see you in the lab again. ..........
.........

Old64,

Sleep labs are very expensive and take a long time to schedule and report results.

What problem do we consistently see with the patients on the forum? In my estimate in maybe 99% of the cases it is ineffective CPAP therapy. It is ineffective because the pressure is wrong, the patient is mouthbreathing with a nasal mask, the mask is leaking, the humidifer is set too high, etc.

So do we advise KittyStar to run out and schedule a very expensive in-lab PSG? Seems ridiculous to me. Instead, take some of that time and money and get a data-capable machine, software and card reader. Let the patient get under control the things that only the patient can control.

I think you understand that optimizing the CPAP therapy should come first:

.........
........but offsetting that is they don't seem to be particularly interested in seeing if your CPAP therapy is actually working before foisting you off on someone else.

.........

I just hope KittyStar and others get the message clearly.

Regards,

[kittystar]

WOW you guys have given me a lot to think about. Day four of the Ritalin and Im not impressed with the results. Yesterday I took my last dose at 3pm and by 3:45 I was so sleepy it was unreal. So I guess that stimulants used in the daytime may not be the answer, since I have not had any improvement in sleep at all. But, one good side effect, the ritalin has nixed my appetite so it would be a good weightloss plan (which I need anyway!!). Also, the PCP noted some symptoms of hypothyroidism and took blood to see if that is the case, but I would think that if I were truly low on thyroid, I would be sleepy......wouldn't hyPER thyroidism be more likely to cause insomnia??
Still confused and sleep-deprived...

[roster]

WOW you guys have given me a lot to think about. .........

Quit thinking. Just order the software and card reader. Shop around. Here is one source: https://www.cpap.com/productpage-bundle.php?BundleID=64

We all need to know what is happening with our breathing while asleep.

[kittystar]

Hey Rooster! I know I have to be pro-active about my therapy BUT how can I even begin to evaluate it when I cannot sleep (with or without the CPAP on) If I could sleep I would have a shot at figuring out whats what. I have asked for my results from the sleep center so I at least have a starting point. I will probably be upgrading to add a smartcard module to my machine; help me understand. I have to add the module to the machine, then buy both the software and the card reader, right??

[cflame1]

Kitty... are you sure that the machine that you have listed is correct?

If so it's fully data capable and you shouldn't have to upgrade it at all or add any kind of smart card module... there should already be a spot for the smart card (whether or not there's one in there)

Just get the software and the reader.

[kteague]

kittystar, getting a copy of your diagnostic and titration studies is a good first step. Often there are irregularities in them that were never discussed, as some things work themselves out after one adjusts to the treatment (a few centrals, limb movements, etc). If that doesn't happen, it's a good idea to revisit the studies. I totally agree about needing to KNOW your cpap is working for you before treating symptoms. You said you don't sleep with or without the mask - surely you're not saying you NEVER sleep? It doesn't take hours on the machine to maybe pick up some useful info. Why go to all the trouble of using cpap then not be sure it's working?

I have been told I have delayed sleep phase syndrome. I used to think I had insomnia, but I believe it was my brain and body avoiding the misery and danger of sleep. The first few months I was on cpap I got worse instead of better, as the settings weren't working for me. Even after correcting that, my Periodic Limb Movement Disorder kept me from sleeping soundly. Also, the brain likes to do what it is used to doing. I finally committed to getting up early with no naps until I broke "the spell". By night 3 I was watching the clock and waiting for it be be late enough to go to bed. Now, those with any kind of chemical imbalance would not find what worked for me to be useful for them.

I hope either the tests your doctor has run or your data will direct you to a cause of your sleep problems. I have taken Adderall and Concerta. Helped a little during the day. Did nothing for my nights. I know the misery of sleeplessness very well. May you find relief soon.

Kathy

[roster]

Kitty... are you sure that the machine that you have listed is correct?

If so it's fully data capable and you shouldn't have to upgrade it at all or add any kind of smart card module... there should already be a spot for the smart card (whether or not there's one in there)

Just get the software and the reader.

Good point.

Kitty, You need to check that. The machine you have listed comes with a blue SmartCard in the slot on the back. If you do indeed have the machine you have listed, then all you need is a card reader and software - just like in the link I posted above.

If you are unsure about which machine you have, give us the model names and number off the top and bottom of the machine.

Regards,

[kittystar]

Rooster; here is the info from my machine--on the top REMstar Plus M Series (with CFlex)
on the bottom: Model: REMstar Plus MSeries
Model#: 200M
Also notes REMstar BiPap
Oh my goodness, if you reef on a little panel on the left side of the back of the machine, there is a space there that has contacts at the very back; that looks like where the module would go in because the space is too big for a card.
What do you think??