UP and AWAKE and need help with a sleep aid decision...

[ronnatal]

I am waiting to review my results for my mild sleep apena with my doc this coming thursday so I can get my CPAP machine.

Until then I have having trouble dozing off without my body twitching to wake itself up before it goes into deep sleep.
I need to try to get SOME rest and thought about taking sleep MD.

http://www.cantsleep.org/reviews/sleep-md.html

or take one 12.5 mg of ambien that the Doc in the E.R. last week perscribed to me when I went in for restlessness.

My oxygen while laying on my side hovers around 93-98% so I'd thought if I took one of these medications while laying in that position I might get some rest... I did take ambien once before (one pill) and it seemed to "reset" my twiching (little jerk of sholders or fingers or toes)... as least for that night (last week)... just don't know if I should do it again.

should I just tough it out and try again to see if I can fall asleep naturally?

Thoughts??? I am so desperate here...

[ronnatal]

Any help please...

[ems]

I'm new to this myself so can't be of much help. I'll bump this in the hopes that someone will see it.

[DoriC]

Hi Ron, when my husband first started therapy he was having trouble falling and staying asleep. The Dr prescribed Ambien 10mg but we cut it in half and he only took 5mg for about 2months until he adjusted with no side effects. I think what the ER prescribed for you is the Ambien CR which is more long-acting to keep you asleep should you awake during the night, half dosage to start and the other half kicks in about 3hrs later. I think you could try it since it was prescribed and you had no ill effects with the one you used before,and maybe get some sleep. Hope that helps.

[robysue]

I am waiting to review my results for my mild sleep apena with my doc this coming thursday so I can get my CPAP machine.

Until then I have having trouble dozing off without my body twitching to wake itself up before it goes into deep sleep.
I need to try to get SOME rest and thought about taking sleep MD.

My understanding is that you don't yet have your machine. And you'd like to try to get some better sleep between now and thursday when you'll talk to the doctor and (hopefully) get your machine.

So a relevant question is this: Before you knew the results of your sleep test did you have this twitching problem? Was that what led to the test in the first place? Or is the twitching brand new?

Because I suppose if it is brand new, then it's possible that you're just dealing with anxiety triggered by being diagnosed---even if you were expecting the diagnosis and especially if the diagnosis was not expected.

If the twitching is not new, I wonder if it is related to the apnea or if you might have PLMD.

And regardless of whether you get any answers about how to sleep better before getting your CPAP, you've got a whole lot of homework to do between now and Thursday.

First: Read and RE-read Janknitz's excellent post What you need to know before you meet your DME. It's got plenty of tips on how to get the machine you WANT instead of the machine the DME wants to give you.

Second: Call your insurance company and find out about your coverage. How much they pay and HOW they pay for the equipment. It's particularly important to know if they pay for the machine by code number. It's also important to understand what your copays for the equipment will be and whether you must meet a high deductible before the insurance company will pick up any cost at all for the CPAP equipment. And note that coverage for durable medical equipment is likely to be quite different than coverage for perscription drugs or medical tests. Also get a list of DMEs that are considered to be in-network so that you can comparison shop the DMEs instead of just blindly going to a DME that the doctor just happened to fax your equipment order (perscription) to.

Third: Start doing some research on the available CPAP/APAP machines. Decide which machines are acceptable to you and which machines are not. Around here, the advice will be to hold out for a machine that records full efficacy data---in other words a machine that records leak data and data about apneas and hypopneas. And perhaps other useful data as well. Without a full data machine, you can't trouble shoot if (when) something doesn't go as smoothly as you and your doc hope things will go. User software should also be a consideration if you hope to monitor your therapy yourself on a daily basis. But don't bother asking the insurance company, the DMEs, or the doc about software choices: They all seem to think folks with OSA are babbling idiots who are incapable of understanding the data these machines record and are inherently incapable of making intelligent decisions about our therapy based on that data.

Fourth: Start interviewing DMEs that are in-network for your insurance. When you call them, you should politely state that you've been recently diagnosed with sleep apnea and you expect to be prescribed a CPAP machine. Then ask them: If I were to use you as my equipment provider, would you be able to set me up with a <machine or machines of your choice>? If the answer is NO, politely hang up and continue looking for a DME that will provide you with the kind of service you want.

Fifth: Do NOT feel as though you must accept a machine that records only compliance data from a DME that you've never heard of on Thursday afternoon just to get your therapy started Thursday night. You will be sleeping with this machine for the next five years (or more) and you will have a five year (or longer) relationship with the DME. If you are NOT comfortable with the hard sell to get you to accept an Resmed S9 Escape or a Philips Resprionics System One Plus with C-Flex when you talk to the DME after talking to the docor, then WALK. Do NOT sign any papers saying you refuse treatment. Simply tell the DME that you intend to purchase your equipment from a different DME that will provide you with the equipment you need. Remember: You are under no obligation to use a particular DME unless your insurance company specifies the DME. And even then, you've got the (possibly expensive) choice to buy everything out of pocket if need be.

Best of luck with that meeting on Thursday.

[avi123]

Taking sleep medication while CPAPing.

It really depends on the cause of your sleep disorder.
Taking a 10 mg of Zolpidem ( generic Ambien) helped me a lot with my fragmented sleep for years, long before starting CPAP for OSA. When I started CPAPing, 9 months ago, I took half a tablet (5 mg) as soon as I mounted the mask at around 11:30 p.m. which let me sleep for 3 hours. Then after going to the BR I took another half a tablet which gave me 3 more hours of sleep. For the hangover the next morning I took two tablets of Tylenol and for the ingested air I took Pepto Bismol.

I have learned about the value of Ambien when I was prescribed it at the hospital after a joint replacement (hip) operation. It’s a true miracle sleep drug as long as you don’t continue on it for long time because of addiction. About 4 months ago I decided to withdraw from it. So I was prescribed Xanax to help me with the withdrawal which I did in two weeks, by following TonyCog approach. See below.

About Ambien:

viewtopic/t28525/viewtopic.php?f=1&t=63 ... og#p593574

and

Sleep without Ambien!!

viewtopic.php?f=1&t=60835&p=570869

******************************************

p.s. here is a true story about those who are against taking Rx (and try very hard to convince others to follow).
When my wife who happened to be a registered pharmacist at the time, gave birth to our first child she decided to do it without taking any sedation. But after 5 hours of labor, boy o boy, she vowed never to repeat it again.

[Cuda]

I am not a doctor and my insurance does not cover anything sleep related so I can tell you a real sleep med horror story in detail, this is not really advice except the part about being careful getting into sleep meds.


Ambien - Lights out but make sure you are in bed and ready to sleep when taking it. Problem, after 3-4 hours it wears off.
Xanax - Habit forming and you build tolerance to it, not designed for sleep but a small dose can help you relax enough to sleep.
Trazadone - Not as heavy as Ambien and last enough to get you through the night, start with small dose.
Over the counter - Can make you jittery, I get restless leg from it and does not do much to make me sleepy.
Promethazine - Makes you sleepy but I had to take to stop throwing up non stop, usually worked unless I was so sick I needed a shot of it. When that failed its to the hospital for a IV to get fluids.

Heavy hitters:

Tamazepam - Lights out like Ambien and lasts like trazadone, habit forming and I was told can make OSA worse. My miracle drug when nothing else worked.
Seroquel - In low doses puts you and keeps you out and keeps you zombied all day, very powerful drug that was not designed for sleep, I would avoid.

Combinations and my personal experience:

Most of these drugs my body built a tolerance for. Since I had OSA (but was unaware I had it) I needed heavy sedation so I could put myself down to thrash around for a few hours and remain sane. I felt terrible. The doses kept getting higher and the number of meds climbed as well. At one point I started calling what I was given the "Heath Ledger" cocktail (no disrespect to him). I was given pain killers (Vicodin) after surgery once and along with everything else it was exactly what killed the actor.

WARNING: These are VERY HIGH doses and should NOT be mixed,if a DOCTOR tries see another doctor! I was a special case and these dosages ramped up over decades.

Pre-OSA treatment:

Xanax 1-3MG - sleep, help with nausea
Ambien 30MG - Put me down
Tamazepam 120MG -put me down, keep me down
Seroquel 50MG - Keep me down
Trazadone 300MG - Keep me down
(other I wont mention) - helped with nausea/vomiting
Promethazine 100MG - Put me down, helped with nausea vomiting


Yes, all at the same time. I would average about 20-30 hours of sleep a week. I would go days on end not sleeping and it got to the point even with the cocktail above I would still not sleep at all most nights. Once weak enough I started getting sick easy and each time my body seemed to have no chance to fight back. Finally I ended up in intensive care for severe dehydration and double pneumonia. My resting heart rate was in the 30s. The lung doc was stunned at the drugs I was on, I mean truly stunned. He was actually upset how insurance was just doing the cheapest thing they could and "hoping I would just die" his words. He ordered a sleep test and I was told by insurance they would not cover that or the therapy. I was so desperate I bought everything myself. My sleep doc told me I would suffer "three to six months of pure hell" and he weaned me off all of them quickly and NO DRUGS for three months. He said at the least I had to hit the "reset button". That is I might need a sleep aid but we have to start at the beginning.

So eight months later I started CPAP again, 0.5MG Xanax and 50MG Trazadone. I was actually given more but I try to keep them at a bare minimum with the goal of not needing them. As I get use to my machine it seems the OSA was the main problem like the sleep doc figured. I sleep 4-6 hours a night and feel MUCH better and I am no longer scared I am going die in my sleep while at the same time kind of hoping I do.

Life is not perfect now but my advice is this, be VERY careful going down the road of sleep aids. I am not saying no one should do them but sleep meds themselves can cause problems with.....SLEEP!

Ambien 5MG does the trick too but fails to keep me asleep (I still have OSA events to work on that wake me). I am working to get to 25MG of trazadone only in the next few months then I will attempt to eliminate that as well.

Good luck but be careful, treat these drugs as a temporary thing. Even Ambien is a GABA blocker so your brain will crank up activity to compensate so when you stop using it you have more trouble than when you started. Whatever you are prescribed I would get a pill cutter and start with very small doses. If you start building up over time you might want to "reset" your system by stopping for a while. ALWAYS ask the doctor first, I was told if I stopped the cocktail I was on cold turkey I could have died. I was also told if I kept it up much longer I would have died anyway.

The more I use cpap the more that "wired" feeling is becoming a "tired" feeling, its the best sleep aid I have in my opinion. After 25 years of hell I am on the road to recovery and feeling human. The doc figures it started with OSA and that eventually caused the insomnia problems, the meds made the OSA worse which made the insomnia worse which meant more drugs which meant.......

I wonder if how I feel now is how humans are suppose to feel. It feels better but I was so sick for so long I really have no idea what normal feels like. Doc says it may take years for the brain to recover from the OSA and decades of using drugs people should not take more than a week or two.

Now:

OSA (AHI 121, AHI 89) Two studies, one at home other at hospital

CPAP - still fine turning therapy
0.5MG Xanax
50MG Trazadone
Sleep Hygiene
Exercise
Normal BMI
NO smoking
Healthy eating
Reduce stress

Future:

Possible surgery
Eliminate all drugs
Maybe see a shrink as I feel like the guys on the movie "Awakenings". Its great to be recovering but I have some issues adapting to it, emotionally and physically.

If it was me I would try all the other suggestions here before sleep aids.

[ronnatal]

Thanks Guys!!!

What I ended up doing was calling my primary doc's nurse. As we opted for a safe route since Thursday is just around the corner.
She said to try Tylenol PM. It didn't keep me asleep all night but got a 2-4 hours of rest. (which was better than nothing)

To answer the twitching question. Today I started calming myself down. Some of the twitching I felt was brought on by the new diagnoses, combined with stress from work, combined with lack of sleep... so over yesterday I was able to help reduce my twitching in bed and during the day by letting myself know (talking to my brain) that this is not deadly and you're probably stressed out and that everything will be ok and that Thursday is coming.

So for it has helped a lot! I seem to have more control over my body and the twitching has significantly reduced.

As far as CPAP machines to buy I am clueless... I was looking at the Resmed S9 Elite
http://www.resmed.com/us/products/s9_el ... c=patients

Thanks robysue! That was great information!!

Thank you avi123 and Cuda!! Great advice on sleep aids.

I totally agree... I only took Ambien once before to help me chill out and get some rest. I never took it more than one night at a time. Since I don't want to get addicted to it.

Tomorrow I am going to start calling my insurance and seeing what they will pay and then DME's in the area.

I think for tonight I am just going to stick with the Tylenol PM until Thursday.

If you have any other awesome suggestions just comment!

[avi123]

Thanks Guys!!!


If you have any other awesome suggestions just comment!

Yes, take the regular Tylenol instead of the PM which contains Benadryl causing the hangover.

But neither helped me fall asleep. Only Benzo or nonBenzo.

But I doubt it that a CPAP would cure your sleep disorders before 3 months on it. That's how long I had to continue taking Ambien.

Get the Resmed S9 Autoset which can be switched to CPAP mode and then becomes an S9 Elite.


Cuda posted:

Heavy hitters:

Tamazepam - Lights out like Ambien and lasts like trazadone, habit forming and I was told can make OSA worse. My miracle drug when nothing else worked.
Seroquel - In low doses puts you and keeps you out and keeps you zombied all day, very powerful drug that was not designed for sleep, I would avoid.

But, check this about Zolpidem (generic Ambien) helping CSAS:

http://emedicine.medscape.com/article/304967-medication


Excerpt:

"Sedative hypnotics: These agents have been used successfully in treating nonhypercapnic central sleep apnea. Temazepam and zolpidem have been shown to be effective under these circumstances and are believed to work by consolidating the sleep pattern, thus minimizing the instability in ventilation induced by sleep-wake transitions. A case series showed zolpidem reduced central apneas, and the overall apnea-hypopnea index, without worsening obstructive events.[35] "

[robysue]

As far as CPAP machines to buy I am clueless... I was looking at the Resmed S9 Elite
http://www.resmed.com/us/products/s9_el ... c=patients

The S9 Elite is a good machine. You might want to try to push for the S9 AutoSet (but beware the S9 Auto Escape). The advantage of an AutoSet is that you can run it in either straight CPAP mode or Auto mode (APAP). But the Elite can only be run as a straight CPAP.

The Phillips Resprionics System One Auto with A-Flex and the Phillips Resprionics System One Pro with C-Flex Plus are also nice machines to aim for. But avoid the Phillips Resprionics System One Plus with C-Flex since it records only compliance data.

The S9 has much more on-board data with a much better LCD.

The exhalation relief systems work differently on the two machines. I think most folks probably can't tell much difference, but some can. And if you can, you'll likely have a (strong) preference for one or the other. See if the DME can let you actually breathe for a few minutes with both machines with the exhalation relief system set at its maximum setting. If you can tell a difference, you'll likely notice it right away.

Software is available for both the S9 (find the link to ResScan from Uncle_Bob) and the System One (Encore Viewer can be bought for $99 from our host, cpap.com and Pro can be downloaded from some torrent sites if I recall). Jedimark's SleepyHead software works with both the S9 and the System One. For alphaware it is remarkably stable and a very useful alternative to Encore Viewer/Pro.

I've used both the S9 AutoSet and the PR System One BiPAP. For software, ResScan is better than Encore in many ways, but I do like the fact that Encore gives you a breakdown of how much time you spent at different pressure levels when running in Auto as well as the pressure curve. For me, I find the Total Leak data in Encore more useful than the Unintentional Leak in ResScan. But that's because my leak rate is consistently below the expected leak rate for my mask, and hence some of my smaller (but still irritating) leaks don't show up in the Unintentional Leak graph in ResScan. When I switched machines, I badly missed the wave form data's presentation in ResScan. But SleepyHead provides that to me. Personally I find SleepyHead's presentation of the data the most user friendly of the three (ResScan, Encore, and SleepyHead).

A final quirk to consider:

The S9 overwrites the detailed wave form data every seven days and the other detailed data every 30 days. Hence to preserve all your data you must download and back the data up at least once a week. The System One doesn't seem to overwrite things as long as the card is not full. And after 4 1/2 months with my current System One BiPAP, my 2 gig SD card only has about 30--40 megabytes of data actually recorded. So it looks like you can run a System One for a very, very long time without the data card getting full. So downloading and backing up data can be done at a more leisurely pace.

[ronnatal]

Thank avi123!

Now that I actually take a closer look at my prescribed meds from the ER he did in fact gave me Zolpidem and not Ambien...
Hmm... I wonder if I should try that tonight?

[Guest]

Now that I actually take a closer look at my prescribed meds from the ER he did in fact gave me Zolpidem and not Ambien...
Hmm... I wonder if I should try that tonight?

I think you should make the same choice as you would for Ambien.

[DoriC]

Zolpidem is just the generic version of Ambien

[sleepdeprivedemt]

Magnesium and zinc, both are natural, inexpensive and work, fast

[jobe2433]

Do yourself a favor and get the S9 AUTO SET. I wish I would have had this machine when I was first diagnosed.