Speaking of low arousal thresholds... (layman needs help)

[yrnkrn]

Very good. In hindsight, seeing how I wasn't on xpap back then, I'm wondering if my daytime symptoms on Trazadone were merely due to not getting restorative sleep. I'm going to look into this and might try the
Traz again... though at a lower dosage. 150mg might have been WAY too much. Thanks for posting your positive feedback.
Z

I am trying 50mg trazodone. So far (one week) I am less fatigued during the day. My Zeo reports much more deep sleep: prior to Trazodone I would deep sleep about 65 minutes nightly. Now about 85. I feel the difference.

[-SWS]

In hindsight, seeing how I wasn't on xpap back then, I'm wondering if my daytime symptoms on Trazadone were merely due to not getting restorative sleep.

Sounds plausible to me...

Additionally, the authors of the trazadone study speculate about two airway obstruction scenarios: 1) partial collapse or narrowing, versus b) more severe airway collapse. The authors speculate raising the CO2 arousal threshold may be detrimental for patients in that second scenario:

The current authors speculate that, in some OSA patients without a highly compromised upper airway, a low arousal threshold could contribute to the severity of their disease and a medication like trazodone might reduce apnoea severity. Conversely, in patients with a highly compromised pharyngeal airway, airflow resistance increases markedly during sleep and complete obstruction of the upper airway is common. In these patients, an increase in the arousal threshold would probably only extend the duration of the apnoea as an arousal will most likely be required to reopen the collapsed upper airway.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732198/

If the underlined speculation by the trazadone researchers is correct, there's a chance you inadvertently worsened some of your apneas by delaying what is essentially a protective CO2 arousal mechanism. Now that CPAP is stenting your airway open, trazadone can conceivably improve your sleep architecture, under the circumstances that: a) you presently experience excessive arousals in response to slight CO2 elevations, and b) your present CPAP pressure does not allow complete airway collapse (necessitating that protective CO2 arousal mechanism).

[yrnkrn]

If the underlined speculation by the trazadone researchers is correct, there's a chance you inadvertently worsened some of your apneas by delaying what is essentially a protective CO2 arousal mechanism. Now that CPAP is stenting your airway open, trazadone can conceivably improve your sleep architecture, under the circumstances that: a) you presently experience excessive arousals in response to slight CO2 elevations, and b) your present CPAP pressure does not allow complete airway collapse (necessitating that protective CO2 arousal mechanism).

My situation may be like what you describe.

Except full EEG, is there any way detect very short arousals at home?

[-SWS]

My situation may be like what you describe.

Except full EEG, is there any way detect very short arousals at home?

I don't know of any method short of EEG to detect arousals. A more practical home approach is to probably compare AHI and subjective assesment, to ensure trazadone does not unexpectedly worsen apneas. Adding a recording oximeter would be a third safeguard measure.

I suppose it's also conceivable that trazadone benefits you by offering its effects as a general sleep aide---rather than specifically working on CO2 arousals.

[yrnkrn]

I suppose it's also conceivable that trazadone benefits you by offering its effects as a general sleep aide---rather than specifically working on CO2 arousals.

There isn't much difference in terms of sleep length, # wakes and AHI with/out Trazodone. If anything I sleep less with trazodone but feel much better the following day (sleeping less without trazodone is very bad). Without trazodone I'm fatigued and tired from midday until night, unless I take a nap the rest of the day is ruined.
With trazodone I'm somewhat tired in midday and the feeling goes away later, as most people. I still prefer to take a nap and it's good but I did manage without a nap it was not that bad. For me it's nothing short of a miracle.

I do see big differences in Zeo reports.
Without trazodone a typical night is 8 hours of sleep composed of 4 hours light, 1 hour deep and 3 hours REM:



With trazodone a typical night is 7 hours, more deep sleep and less REM:



The yellow note means that the signal was lost.
Other nights with trazodone I got more REM, about 2 hours, but markedly less than the 3 hours pre-trazodone.

All nights I get deep sleep in all NREM cycles up until wakeup.
With trazodone I consistently get 80something minutes of deep sleep compared with 60something before.
I understand this is unusal as deep sleep is supposed to be in the first cycle and the first half of the night.
That this kind of sleep is typical in depression but I'm not depressed, really. When I get my proper sleep, (without trazodone I NEED my midday nap) I'm OK.

What does this mean?

[Zzzzzzzzzzz...]

Quick report. I took 50mg of Trazodone last night. AHI was lowest I've EVER had. 2.03. CA 1.80. OA .23. A 0.00. H 0.00!!!! Leaks 3.60 max. Median/95% ZERO. Might be onto something. Only question now, is whether I take it during my study tomorrow night, or Lunesta.

Very interesting...

Z

[yrnkrn]

Only question now, is whether I take it during my study tomorrow night, or Lunesta.
Z

Trazodone will change your sleep study results. Lunesta maybe less. Best study would be without any medication. Not an easy decision.

[Zzzzzzzzzzz...]

Only question now, is whether I take it during my study tomorrow night, or Lunesta.
Z

Trazodone will change your sleep study results. Lunesta maybe less. Best study would be without any medication. Not an easy decision.

I won't sleep at all otherwise. But as others have indicated as well, Lunesta may be the better option if I want an accurate study.

Z

[Pugsy]

Been watching this discussion. Got me to rethinking a few things (dangerous for me). While I rarely have any centrals to worry about...the low arousal threshold thing sure does mess with overall sleep quality and this is why I take something at night so that pain doesn't wake me up. Gotta get some sort of uninterrupted sleep to have any hope of feeling better.

Taking something like Lunesta or Ambien might be a better choice for a sleep study since the chance of it messing with possible post arousal centrals might be less...since we don't know for sure about those meds and we do know about the trazadone. Gotta get some sleep to have a sleep study but if you sleep through the post arousal thing with the aid of meds then the sleep study may not catch your possible problem. Damned if you do and damned if you don't type of thing.

[-SWS]

Quick report. I took 50mg of Trazodone last night. AHI was lowest I've EVER had. 2.03. CA 1.80. OA .23. A 0.00. H 0.00!!!! Leaks 3.60 max. Median/95% ZERO. Might be onto something. Only question now, is whether I take it during my study tomorrow night, or Lunesta.

Well, if it were me I would place a doctor-supervised trazadone experiment on the very back burner for now. As others have mentioned, trazadone stands to obscure the very phenomena you hope to address usng PAP treatment over pharmaceuticals. If you do end up exploring trazadone in the future, then please get your doctor in the loop for a pharmaceutical experiment like that. Again, good luck with your PSG tomorrow...

While trazodone is not a true member of the SSRI class of antidepressants, it does still share many properties of the SSRIs, especially the possibility of discontinuation syndrome if the medication is stopped too quickly.[44] Care must therefore be taken when coming off the medication, usually by a gradual process of tapering down the dose over a period of time.

http://en.wikipedia.org/wiki/Trazodone#Warnings

[Zzzzzzzzzzz...]

Quick report. I took 50mg of Trazodone last night. AHI was lowest I've EVER had. 2.03. CA 1.80. OA .23. A 0.00. H 0.00!!!! Leaks 3.60 max. Median/95% ZERO. Might be onto something. Only question now, is whether I take it during my study tomorrow night, or Lunesta.

Well, if it were me I would place a doctor-supervised trazadone experiment on the very back burner for now. As others have mentioned, trazadone stands to obscure the very phenomena you hope to address usng PAP treatment over pharmaceuticals. If you do end up exploring trazadone in the future, then please get your doctor in the loop for a pharmaceutical experiment like that. Again, good luck with your PSG tomorrow...

While trazodone is not a true member of the SSRI class of antidepressants, it does still share many properties of the SSRIs, especially the possibility of discontinuation syndrome if the medication is stopped too quickly.[44] Care must therefore be taken when coming off the medication, usually by a gradual process of tapering down the dose over a period of time.

http://en.wikipedia.org/wiki/Trazodone#Warnings

I'm in complete agreement. And just to clarify... when I was originally prescribed traz. it was use as a pain/sleep med and under the watchful eye of my physician. I'm aware of the concerns surrounding stopping it, dosing and tapering off, etc... I have every intention of giving myself a fair shot at this next titration. And taking traz. will indeed mask any useful information gleaned from the study. However, knowing that I won't sleep a wink and if I did, it wouldn't be enough for any conclusive results, I'm opting to take Lunesta (2mg) to at least give it all a fighting chance. Thanks again for the support and concern. Will post back with my results.

Z

[avi123]

When I started CPAPing 18 months ago one of my Internists/Geriatrics gave me to take 100mg Trazadone in the evening and give up the 10 mg Zolpidem (generic Ambien) that I been taking before for almost a decade for sleep, in addition to taking 10 mg of Paxil in the morning. But the Traz did not put me to sleep as the Zol did within 15 to 30 min. So I stopped the Traz and went back to the Zol. After 3 months I have decided to withdraw from the Zol even though the Zol did a good job for about 4 hours. To fall asleep again I took half the dose once more. My new Psychiatrist suggested that I take Alprazolam (generic Xanax) 0.5 mg ER twice daily and also 300 mg Gabapentin, only once before sleep, and drop the Zol but continue taking the 10 mg of Paxil. In the meantime I convinced the Shrink that I should drop one dose of the Xanax and take it only once daily in the evening. It works good. I been sleeping soundly for 7 hours with the CPAP and have two breaks for peeing with no problems falling back to sleep. After 7 hours I stop the machine and continue sleeping with the chinstrap for another hour. I read that a chinstrap stops snoring by lifting the chin. But I continue to suffer from some RES (Residual Excessive Sleepiness) after breakfast till noon.

Doing two night studies recently, if I could not fall asleep within 30 min, I got permission to take 10 mg of Zolpidem tablet [again], which put me to sleep in 15 min.

[DoriC]

I'm in complete agreement. And just to clarify... when I was originally prescribed traz. it was use as a pain/sleep med and under the watchful eye of my physician. I'm aware of the concerns surrounding stopping it, dosing and tapering off, etc... I have every intention of giving myself a fair shot at this next titration. And taking traz. will indeed mask any useful information gleaned from the study. However, knowing that I won't sleep a wink and if I did, it wouldn't be enough for any conclusive results, I'm opting to take Lunesta (2mg) to at least give it all a fighting chance. Thanks again for the support and concern. Will post back with my results.
Z

Our instructions for my husband's sleep study included getting an RX for Ambien(5mg) in case he couldn't sleep. He did use it for the study and the titration and continued to use it on and off for the first 3months of therapy. We were told Ambien does not have any adverse effects on OSA and in fact may be beneficial. When he was in the hospital recently they were giving him Ambien per Dr's orders if he wasn't sleeping within 30 mins to an hour.

[avi123]

zzzzzzzzzzzzzzzzzzzzzzzz, I don't buy Dr David Rapoport stories about the usefulness of the Provent more than the PEEP method which has been used for years in operation rooms by anesthesiologists and in ICU by the ventilators. Is it possible that Dr Rapoport did not know about it?

See my previous post on it:

The Provent device is nothing more than a simple PEEP creator (PEEP = Positive End Exhalation Pressure).
For years, Anesthesiologists and Respiration Therapists, have been using this technique on certain patients
in the operating rooms and in surgical intensive care units.

See here how PEEP works:

http://www.ccmtutorials.com/rs/mv/page14.htm

I could create a PEEP in a regular mask while CPAPing by plugging SOME of the intentional vent holes, or using a ventless mask and installing a PEEP valve at the inlet to the mask. The valve creates 2 to 3 cm of exhaling pressure above athmospheric pressure. It is adjustable.

PEEP valve for low exhalation resistance:

[-SWS]

The valve creates 2 to 3 cm of exhaling pressure above athmospheric pressure. It is adjustable.

The traditional PEEP valve creates 2 to 3 cm because that's how much pressure happens to be required for intended PEEP-valve applications.

Provent creates more than 2 to 3 cm by presenting much higher expiratory resistance than PEEP valves. The Provent valves are intended for an entirely different application than lower-resistance PEEP valves....

zzzzzzzzzzzzzzzzzzzzzzzz, I don't buy Dr David Rapoport stories about the usefulness of the Provent more than the PEEP method which has been used for years in operation rooms by anesthesiologists and in ICU by the ventilators. Is it possible that Dr Rapoport did not know about it?

He's a researching pulmonologist who has written about PEEP.