will sleeping pils help adjust to ASV ortake longer

[wilsonintexas]

I am headed to an ASV machine (YEA FINALLY).

On BIPAP I wake a few times a night but can not tie it to anything specific. Sometime it is at the end of a cluster of centrals (with a peak AHI of 30-50) for the cluster.

I have NOT noticed it related to pressure ramps. (I am on auto bipat and it ramps from 10-13 once in a while). I expect the ASV to go to 18-20 to help the centrals. (I still have to check the prescription.)

My sleep DR did not want to prescribe sleeping PILLS while on BIPAP because the centrals could get worse, so I am on NUVIGIL, and pretty happy with it.

But I hate to take a wakey pill when the problem is sleeping.

I expect it will take a while to adjust to ASV. My centrals come in clusters as I go into REM, and it will have some work to do. I also have a lot of CSH (CHS?) breathing before and after the clusters, as well as events throughout the night. So I am expecting a very active machine.

So the question, IF I take sleeping pills, will it help while I adjust to the ASV machine? It should be handling the centrals when they come up, and I may be able to come off of the wakey pills.

I am also planning on using it during the evenings to help get use to it.

Any other ideas of what will help make the transition smoother?


But the real important question for me is on sleeping pills.

[nanwilson]

Hi Wilson
I take 20mg of amitriptiline at bed time every night, it is not a sleeping pill per say, but helps with relaxing and staying asleep....no residual drowsiness in the am....so no wakey pills needed. It would probably help you transition to the asv much easier. There are a number of us hosers on it, I am sure that one or two of them will chime in shortly and give you their two cents worth.
Cheers
Nan.

[old64mb]

Hopefully, when you get your centrals treated on the ASV you can discontinue the Nuvigil.

You may find that adapting to the SV doesn't take much since you're operating on so little effective sleep that your body will be playing catch up and your sleep architecture will finally have a chance to heal, meaning you won't need any meds. That's one possibility.

The other is that a lot of SV users do report that latency can be a bit delayed because the machine will view the centrals everyone gets while falling asleep as centrals to be treated, which ends up waking some people up just as they're falling asleep. It's something that some people do occasionally take meds for.

Won't know until you try, and I wouldn't worry about it until then.

[JohnBFisher]

... The other is that a lot of SV users do report that latency can be a bit delayed because the machine will view the centrals everyone gets while falling asleep as centrals to be treated, which ends up waking some people up just as they're falling asleep. ...

That was my experience. But rather than medicate to get past it, I just kept reassuring myself that it meant the machine is doing for me what I was not doing properly: BREATHING! ... It just took a couple weeks before I now WELCOME the increase in pressure. I know that I can fall asleep without worrying if I will breathe or not. It does take a little bit of time to adjust. But as old64mb noted, I was SO desperate for decent sleep that it really did not take all that long for me to adjust to it.

That's my own situation. Yours might differ. Hopefully, however, you will find much better sleep and will welcome the new therapy.

[MAXDRI]

I am using ResMed S9 Vpap Adapt and have been taking Ambien CR. Yes, I have read all the warnings. Yes, I have researched it extensively. My neurologist, sleep doctor, & primary physician feel that the benefits (for me) far outweigh any side effects. I now go to sleep promptly, usually sleep 7 hours, wake up refreshed, and my AHI readings are frequently 0. My grown children discourage me from taking them. I have tried to stop and after a miserable month or so, resumed taking them. They do make both my nights and days better. Just one opinion and I'm sure many will disagree.

[Xney]

Definitely something you want to discuss with your doctors, but I don't think a sleeping pill is an evil thing for a while to help you sleep.

I had a pretty easy transition to ASV from bi-level, though admittedly I don't have a ton of centrals. It might go smoothly - try it without a pill first. It could be your untreated central events are more a problem than sudden air changes..

[wilsonintexas]

Thanks for the comments. I have already asked the DR about a prescription, but have not gotten a reply.... will followup today. I would like to sleep better. Even on the nuvigil, I am hesitant to do things in the evening, like wood working with power tools..... Just to worn out.

Most of my centrals are not transition into sleep, but in later stages. I usually get clusters around 1:30 - 2:30 and 4:30 - 5:30.... Maybe I will be in enough sleep that I do not notice the machine kicking in......

Right now, if I had my choice, I wood try the first weekend without sleeping pills, but would want them for the first week. If nothing else I would like some good sleep. I got one prescribed for the ASV sleep study, and when I woke up, it was the best I have felt for a very very long time.... I would like to repeat that for a while.

When I wake up during a cluster, I have a very clean hour or two with nothing, then they start up again.....

I do not have a zero, but going to sleep is usually pretty quick, it is rare for me to be awake for more that 15-20 minutes...... It is the waking up at 12:30, 2:00, and 4:00 that gets to me.

[avi123]

Taking only a small dose (5 mg) of Zolpidem, to fall asleep, sounds ok to me.

CAUTION

Withdrawal From Zolpidem

http://www.non-benzodiazepines.org.uk/zolpidem.html

[old64mb]

... the use of zolpidem and triazolam in the setting of primary CSAS is not a preferable option and remains the last therapeutic option, to be considered only if the other therapeutic options listed above fail.

Eh, not exactly.

For anyone who wants to read the full article - http://www.aasmnet.org/Resources/Practi ... rs/CSA.pdf - it's a summary of recommended guidelines for treating CSA, CSR, and other central-predominant conditions based on a metaanalysis of the very limited studies on the subject (5 studies with 51 total participants for the section on primary centrals, for instance.) Fairly interesting reading if you're looking to chase the references they use, as there were a couple of studies I've missed and will need to look up when I have time.

What that particular guideline is discussing is treatment options for central-predominant SA if options 4.1.a: (Positive airway pressure therapy may be considered for the treatment of primary CSAS) and 4.1.b: (Acetazolamide has limited supporting evidence but may be considered for the treatment of primary CSAS) have already failed. It does not discuss usage of hypnotics or benzos alongside ASVs.

Section 4.2.3 deals with Adaptive Servo-Ventilation (ASV) and makes no recommendations regarding this either.

Hence, I would reiterate what I said earlier - it may or may not be a little bit of an adaptation, but not something to worry about until you actually try it.

[avi123]

There are several different forms of CSAS:

(wilsonintexas, probably doesn't know exactly what kind he has)

The International Classification of Sleep Disorders (ICSD)–
identifies 6 different forms of CSAS: (1) Primary Central
Sleep Apnea, (2) Central Sleep Apnea Due to Cheyne Stokes
Breathing Pattern, (3) Central Sleep Apnea Due to Medical
Condition Not Cheyne Stokes, (4) Central Sleep Apnea Due to
High-Altitude Periodic Breathing, (5) Central Sleep Apnea Due
to Drug or Substance, and 6) CSAS in Infancy.

Each is different, and requires different treatment.

We don't know what type of CSAS Wilson in Texas has.

To come now and tell Wilson, "I take this or that medication before sleep" or "This and that was my experience", is meaningless.

[JohnBFisher]

... To come now and tell Wilson, "I take this or that medication before sleep" or "This and that was my experience", is meaningless. ...

Not necessarily. I respectfully and strongly disagree with that statement. If WilsonInTexas takes that information with him to discuss with his doctor, it might offer options his doctor would not otherwise consider. Remember, the benefit of a large user base is not just for the user, but also for experts that interact with that user base.

For example, I take the generic of Remeron. It's an antidepressant, whose known side effect is an improvement in sleep architecture. This is off label use that another doctor might not have considered. Is it for everyone? No. Will it help WilsonInTexas? I simply don't know. Will it help as an input for the doctor that WilsonInTexas sees? Who knows?!

But I do know that sharing my experience is NEVER wasted. And it might just help. There are plenty of people on this forum, who benefit from the experience of others.

[old64mb]

Each is different, and requires different treatment. We don't know what type of CSAS Wilson in Texas has.

Actually, we do.

Wilson has already stated that he has complex SA, which among other things is not at all covered in the article you keep bringing up. To quote the relevant section, "The diagnosis of Complex Sleep Apnea Syndrome...is not a part of the ICSD-2 nosology." (Another extremely relevant quote is that "the existing literature highlights the paucity of data available on the treatment of central sleep apnea syndromes.")

... To come now and tell Wilson, "I take this or that medication before sleep" or "This and that was my experience", is meaningless. ...

I'd suspect this category would also include posting something by "A group of (non-medically trained) voluntary support people" regarding how to wean someone off of 4x the maximum dosage of a drug once it's been taken for far longer than recommended. I mean, if you want professional insight on the subject I could dig up this journal article I found a while back on how some poor fool who somehow got up to 300 mg of zolpidem per night got detoxed, but I don't think it's terribly relevant to wilsonintexas either.

Wilson wanted to know about how transitioning to an SV works, since it's unlikely his DME or MD knows. He's gotten good responses from people who have transitioned.

[BlackSpinner]

And another bit of information that might or might not be relevant

http://www.cbc.ca/news/health/story/201 ... xiety.html

"In this large, prospective, population based study of people who were free of dementia and did not use benzodiazepines until at least the third year of followup, new use of benzodiazepines was associated with a significant, approximately 50 per cent increase, in the risk of dementia," Bernard Bégaud of the University of Bordeaux and his co-authors concluded.

[avi123]

I go by U. S. studies:

In Apr. 2009


Improvement of Idiopathic Central Sleep Apnea with Zolpidem

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670330/

Excerpts:

Study Objectives:

We hypothesized that the non-benzodiazepine hypnotic zolpidem would improve idiopathic central sleep apnea (ICSA) by enhancing sleep stability, resulting in fewer arousals, which in turn would lessen oscillation in arterial CO2 and produce a decrease in central apnea/hypopnea events. Zolpidem might also decrease ventilatory control responsiveness during arousals, thereby reducing hyperpnea, hypocapnia, and subsequent apneas.

and

In summary, in an open-label, uncontrolled study, in ICSA {Idiopathic Central Sleep Apnea} we have shown that the hypnotic zolpidem decreased the central apnea and hypopnea frequency, decreased arousals, improved sleep quality, and resulted in a subjective improvement in excessive daytime sleepiness without worsening oxygenation or obstructive apnea/hypopneas, except in 3 individuals who experienced a significant increase in obstructive events

Comment,

I take both Xanax and Ambien but in small doses. I take Alprazolam (generic Xanax) ER 0.5 mg daily in the evening for daytime anxiety. I also take Zolpidem (generic Ambien) 5 mg, only when I can't fall a sleep within 30 min. Besides the above I also take 10 mg generic Paxil daily. Generally, almost all drugs have side effects. I don't have Central Sleep Apnea Syndrome, but a few CAs events show up in my sleep data. I could take the new Rx Cymbalta (30 mg daily) and drop all the above and another Rx that I take( Gabapentin). But it's too new to take chances on it and EXPENSIVE.

I think that the medications that I take help me fall asleep and sleep for 7 hours. IMO, they have no bad effects on my treatment.

See the last 60 days Statistics of my treatment:

[wilsonintexas]

Some interesting discussions......

BUT

The root question really was the following:
- Given - I am going to an ASV machine
- Given - I am currently not sleeping well on a auto bipap
- given, I am having to take NUVIGIL now to function during the day

(I also tend to be very sensative to things that make people sleepy, allergy pills knock me out)

- assumed - ASV will take a while to adjust to

Will sleeping pils help during the adjustmemnt time????

or

If I am on the sleeping pill, my body will not adjust because it is under the influance.

This is not really about long term use, it is will it help during the adjustment period.....

I am getting my ASV machine delivered tomorrow
The DR has perscribed zolpidem tartrate 5mg.

I will try the first few nights without the sleeping pill and see how it goes......

I amy wait until Friday night, in case I have problems getting up in the morning to see how it is going.

Thanks again for the support.