Falling asleep at the wheel

[recantha]

Hi all. First post.
I was diagnosed with OSA about 18 months ago. Late last year, I finally got my hands on a CPAP machine and it's going pretty well in terms of comfort and use.

However, one problem I've always had is sleepiness while driving or travelling as a passenger. This morning was insane - had to stop to nap on the way and even then the sleepiness continued. I finally got into work after having been very close to a dust cart all of a sudden while in queueing traffic.

I can't _not_ drive, so I was wondering: does anyone have any quick fix food, drink or medication that they use to boost their alertness in emergencies? I'm on antidepressants and lithium for a bipolar condition, so your normal stimulants aren't necessarily an option.

Hope someone out there can help!


--
Mike

[Askel]

Mike

I can't say I have the same regimented medicines you do, but I have had the same problems in driving prior to using my CPAP.

So I'm compelled to ask this question first. Are you using your equipement throughout the night? If you are and still experiencing sleepieness, then I'd imagine the problem is beyond food or drug stimulus to keep you going. There are much wiser people on this board than I, but I'd go back to your doctor as quickly as possible and discuss the problem.

Just my initial thought. Good luck though. CPAP changed / saved my life.

Phil

[nobody]

Those medications are probably what's causing it. Are you sure you even have bipolar? These sleep disorders can cause symptoms that look identical to mental illnesses.

[ColinP]

I battled with drowsiness at the wheel for many years before I was diagnosed with OSA. (I nearly killed myself and 6 labourers when I fell alseep at the wheel in 1985 and left the road). I've tried eating different things, drinking coffee or Red Bull, and nothing really made any difference. Getting the blood flowing helps for a while - move around, scratch yourself, massage your shoulders or even get out the car and walk up and down for a bit, all help for a while but you get drowsy again. Sometimes I've been able to keep awake by doing mental calulations - time a mile with your watch and work out your speed to 5 decimal places in your head, calculate exactly when you'll arrive at the next town and try to keep to it, but if you're really tired you can't concentrate so that isn't a good solution either. Increasing speed has it's benefits - you're then going faster than the traffic and the mental concentration needed to overtake keeps you awake too, but only if you're moderately tired. If you're too tired, going faster just makes the accident more spectacular.

But in the end, you need to sleep enough so that you're not tired while driving, as no 'stay awake' method is foolproof. If you're tired while driving, you're a danger to yourself, your passengers and the unsuspecting guy in the car in front of you. It sound as though your OSA treatment hasn't kicked in properly yet. I'd try to get some idea of what your AHI figure is and get that low enough so that you don't feel tired in the first place, and try to limit the driving while you do that.

Colin

[Wulfman]

Hi all. First post.
I was diagnosed with OSA about 18 months ago. Late last year, I finally got my hands on a CPAP machine and it's going pretty well in terms of comfort and use.

However, one problem I've always had is sleepiness while driving or travelling as a passenger. This morning was insane - had to stop to nap on the way and even then the sleepiness continued. I finally got into work after having been very close to a dust cart all of a sudden while in queueing traffic.

I can't _not_ drive, so I was wondering: does anyone have any quick fix food, drink or medication that they use to boost their alertness in emergencies? I'm on antidepressants and lithium for a bipolar condition, so your normal stimulants aren't necessarily an option.

Hope someone out there can help!


--



Mike

What took you so long to get on the hose?
You didn't fill out your profile, so we have no idea what equipment or pressure you're using.
HOWEVER......I'm going to guess that you're using a nasal mask and during the night your mouth is falling open and all your therapy air is escaping. That means you're not getting much of any therapy. Ever wake up with a dry mouth? That would be a clue. You need to either seal your mouth (tape) or use a full face mask.
If you don't have a data-capable machine, it's also hard to tell if your therapy is working.....other than by "how you feel".

Den

[Slinky]

Sorry you are going thru this, Mike - BUT - stay the h*ll away from driving a car until you get this rectified. You DON'T want to kill or mail someone.

Your CPAP therapy is ineffective. Why is anybody's guess, but - it isn't effective. Whether you need to master your leak problems, need a pressure change or what you need to get back to your sleep doctor and get the problem resolved! He should be consulting w/your psychiatrist or whoever is scripting and monitoring your med regimen.

As mentioned in an earlier post: tell us what brand and model CPAP you are using, what mask you are using and what your pressure setting(s) is. We may be able to find your data. Either way you have two doctors sharing the responsiblity for improving your sleep and rest and to make it safe for you to drive again. But the ultimate responsibility is YOURS.

You've been handed a double-whammy. Good luck and God bless.

[Woody3]

If all else fails there is Provigil. But I recomend making sure your cpap theripy is going as well as it should right mask,
proper pressure ect. before asking your doctor for it. There is a duscussion on this board about it. It made me realy irritable
I was almost scared to use it I was that irritable and it's ~ $360 a month for the standard dose if your insurance won't cover
it. Now I still want to sleep a lot but don't have any trouble staying awake behind the wheel any more. Before cpap I had a
couple of close calls nodding off for a moment and then waking up but no accidents.

[SheZAAM!]

It sounds like either your CPAP isn't working or you are overmedicated. It's hard to say if the sleep apnea caused bi-polar/depression symptoms or if you truly have both.

I'd get another psych eval and explain the sleep apnea so they can consider that. And....Lithium is sooooo 1980. There's better drugs out there that won't destroy your kidneys.

And I'd talk to your doc about your problems. Work on your CPAP machine before you jump into yet another pill.

[kteague]

Hi. I can't personally speak to the meds for mood disorders, just what I've read on here where others have reported being misdiagnosed and no longer needing meds after on cpap and others that their dosage needs changed. That would be worth looking into.

When I first came here I had deteriorated on cpap and even quit. I have issues with Periodic Limb Movement Disorder, with repetitive contractions/jerking when asleep. When I reported to my doctor that I was experiencing repetitive small head jerks when driving, they said I was driving while asleep. Now that scared the dickens out of me! Turns out the med I was on was causing the sleep symptoms to cross over into when technically awake, but what felt like dozing. Did fall asleep at the wheel once.

A real friend of mine told me once that she didn't appreciate me being on the road endangering everyone else. I'm big on anti drunk driving, yet here I was more impaired than most. Then I came here, and was challenged to stay off the road until this was resolved. One man was recently widowed - his wife had fallen asleep at the wheel not far from their home. His plea struck home and I voluntarily took myself off the road until I worked through the issues. Optimizing my cpap therapy helped the worst of my symptoms. The PLMD still runs in waves of working and not working, but it was the ineffectively treated OSA that was incapcitating me. I still "ground" myself and curtail my driving when I'm not feeling alert. I've come to see it as a matter of personal responsibility.

In your circumstance, please have your doctor continue to pursue why your sleep is not restful enough for you, and what measures are needed to remedy your daytime sleepiness. I am sorry I cannot offer solutions. I currently am taking Provigil, but it should not be considered a replacement for good sleep. Best wishes in finding what's causing your continued sleepiness.

Kathy

[Bluebonnet_Gal]

I can sooooo relate to your story. For more than 10 years, I commuted over and hour each way to and from work. I'm certain I had OSA for more than half of those years (progressively getting worse). At the time, I didn't know what was causing my sleepniess at the wheel. I only knew that my dad had the same problem, so figured it was something inherited. Now I know I inherited OSA (or at least the condition that caused it) from my dad!

I found that eating something was the best to help me stay awake. Terrible for my waistline, but it helped me avoid accidents. I had several very close calls and numerous other times that I started to drift off the roadway. Once I had a blow-out due to drifting off the road into a concrete barrier. I was fortunate and never suffered a sever accident due to my sleepiness.

First, avoid driving as much as possible. If you have to take a long trip, get someone else to drive you whenever possible. You need a data capable machine to see if you're getting the proper treatment. Also, check with your Docs if your meds cause sleepiness.

Another thing - I've been on xPAP treatment about 5 weeks and though I'm not a exhausted as I used to be, I still get sleepy at the wheel. My therapy is not fully optimized yet, so I know it will get better. We also develop a "sleep debt" that has to be paid before we feel optimal results from our therapy. If I understand correctly, the sleep debt increases with the amount of time a person has suffered from OSA and depending on the severity of the OSA.

You have a lot of things going on. Don't give up or just "live with it" - things CAN improve!

[Debjax]

Sorry you are going thru this, Mike - BUT - stay the h*ll away from driving a car until you get this rectified. You DON'T want to kill or mail someone.

Yes, those postal sorting machines leave such unsightly marks.....

Seriously though, the posters ahead of me all have good suggestions...however I would add one more...have the doc screen you for narcolepsy.

[Goofproof]

The main thing is using a data capable XPAP with software, and controlling leaks, like Den said. Med's can be bad too but I'd bet on your treatment not being effective first.

As far as Lithium, you have lab tests to check for damage, just because if a old drug doesn't mean it doesn't work. It was better for my wife than what she's been on for two years at ten times the cost. Jim