Ambien and sleep apnea: GOOD NEWS

[stvgrayson]

I HAVE OSA AND USE A CPAP MACHINE NIGHTLY. MY AHI IS USUALLY IN THE RANGE OF 10 TO 20. THEN I ADDED 5 MG OF AMBIEN AND IT’S NOW ALMOST ALWAYS NOW 0 TO 5! I SPOKE TO MY PULMONOLOGIST AND HE SAID THAT AMBIEN ACTUALLY IMPROVES APNEA, ESPECIALLY CENTRAL SLEEP APNEA.
That me, because I was under the impression that it might make my apnea more frequent.

Have any of you had experience using CPAP and Ambien as an adjunct?

[Rubicon]

Have any of you had experience using CPAP and Ambien as an adjunct?

Do a forum search esp. posts from member SAG. This has been around since 2008.

[lazarus]

The drug may have its place for some people. But hopefully clinicians are fully aware of the relatively recent (2022) update of the safety information for when that information applies:

https://sleepreviewmag.com/sleep-treatm ... pioid-use/

And the overall consensus, especially for those with an OSA component to SDB (as opposed to those with so-called primary CSA), still seems to be as follows, according to the authors of a recent small study:

"Overall, the effect of zolpidem [Ambien] on the severity of SDB remains uncertain. Some studies . . . demonstrated decreased SDB severity, whereas no change was detected in several other studies in patients with OSA."--https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9470768/

And of note, the authors of that small study published in 2023 stated the following as to Ambien and CSA:

"While a decrease in nocturnal arousals was achieved with a single dose of zolpidem, the reduction in AHI was modest and of questionable clinical significance. . . . Therefore, zolpidem does not seem to offer an alternative to current CSA treatments, including PAP, oxygen, and acetazolamide. The long-term tolerability profile of zolpidem in patients with CSA and the effect of long-term treatment with zolpidem on the severity of CSA remain to be determined. Our data do not support the routine use of zolpidem for CSA treatment."

That said, I have no doubt that the drug is beneficial for some using PAP and some not using PAP.

[Olivia]

Well, it is a double edged sword. Yes, it works, but you then build up a tolerance and need a stronger dose and it wears off quicker. Then because your body gets used to it, if you miss a dose you have rebound insomnia. It can only be filled every 29 days and if that’s the weekend or your prescriber is on vacation you will miss doses. And because it is a drug of abuse I have been shorted a full refill several times. After talking to the head pharmacist at CVS, she told me they double count so no mistakes. but, it was one person counting not two. That is an easy way for staff to steal drugs. Then if you go on vacation and don’t have enough to cover your trip, you will again have rebound. Some countries sell it over the counter with no Rx. But recently drugs have been contaminated with Fentanyl in Mexico so that’s very risky. It’s important to have a clear picture of the pitfalls before you start regularly taking this med.

[Rubicon]

And of note, the authors of that small study published in 2023 stated the following as to Ambien and CSA:

And in bad sleepers there may be a massive difference between CPAP machine AHI and PSG AHI-- IOWs, AHI per se wasn't improved, sleep was improved.

[lazarus]

And of note, the authors of that small study published in 2023 stated the following as to Ambien and CSA:

And in bad sleepers there may be a massive difference between CPAP machine AHI and PSG AHI-- IOWs, AHI per se wasn't improved, sleep was improved.

Well said. SAG must have had a real influence on you!

The mixed bag of improving sleep with a drug that for many can cause sleepiness, sluggishness, slow thinking, dizziness, etc., can be difficult for me to process for long-term use, since I have no experience with it.

If you don't mind my asking, Rubicon, did you ever personally hear of or witness in patients many/any benefit (objectively measured) from long-term use?

[ozij]

Have any of you had experience using CPAP and Ambien as an adjunct?

Do a forum search esp. posts from member SAG. This has been around since 2008.

Ahem...
Don't search for posts from SAG, you'll get the wrong posts....

The real SAG, a true lover of acronyms can only be found as StillAnotherGuest.

And do beware of the copycats, one of them who tried SAG, and another who tried StillAnotherGuess....

[Rubicon]

If you don't mind my asking, Rubicon, did you ever personally hear of or witness in patients many/any benefit (objectively measured) from long-term use?

Negatory, but I would not be doing that follow-up.

Anyway, keep in mind that the primary intervention for insomnia is CBT-I, and we had a guy on staff.

CPG:

https://jcsm.aasm.org/doi/10.5664/jcsm.6470

The discussion of zolpidem considers 3 aspects:

Insomnia of some sort;

Breathing instability; and

A combination of the 2.

IMO this is a whole lot more involved than thinking that Ambien is the simple solution to elevated Oscar AHIs.

[lazarus]

CPG:

https://jcsm.aasm.org/doi/10.5664/jcsm.6470

Ain't exactly a ringing endorsement, eh?:

In summary, the task force found that there was weak evidence of efficacy in the treatment of sleep onset and maintenance insomnia . . . Benefits were deemed to marginally outweigh harms.

I guess in this context, "weak evidence" does mean some real evidence, and of course "marginally" could be used to describe a lot of mainstream drugs' benefit-to-risk profiles. But still.

[ElusiveSleep]

Why some PAP users might need sedatives -

"The need for such medicines seems to be related to the PAP side effect of increased awakenings rather than baseline impaired sleep."

Compliance in the author's practice went from 79% to 90% after treating the non-compliant ones with trazodone, mirtazapine or doxepin.

--> Sangal RB. Baseline Sleep Efficiency and Arousal Index Do Not Predict Who Will Benefit From Sedatives in Improving Positive Airway Pressure Adherence in Sleep Apnea to 90. Clin EEG Neurosci. 2018 Jul;49(4):285-289.

https://pubmed.ncbi.nlm.nih.gov/28530153/

[lazarus]

Or, of course, because they just wanna be.

( https://youtu.be/bm51ihfi1p4?si=i660Vv0EVbCf9bC9 )