Events High when taking Ibuprofen and Higher on Tramadol

Hello all - Brand new to the forum. Started CPAP January 2016 and have had some pretty good results.
One thing stands out, some nights events were very high. I started to pay attention to what I do differently on those nights.
Two things became clear:
I generally slept much deeper on the nights with high events, drool all over the pillow kind of deep sleep
I took either Ibuprofen or Tramadol on the nights with high events (recovering from broken ribs).

To test my theory I downloaded SleepyHead and looked at three nights data.
First without any pain meds. AHI was 1.03 (0.91 Obstructive, 0.13 Clear) and CSR 0%
Second with Ibuprofen. AHI - 16.05 (3.44 Obstructive, 0.89 Hypopnea, 11.72 Clear) and CSR 9.4%
Third with Tramadol. AHI - 32.25 ( 7.93 Obstructive, 0.55 Hypopnea, 23.78 Clear) and CSR 13.26%

any insight would be great.

338Baloo wrote:Hello all - Brand new to the forum. Started CPAP January 2016 and have had some pretty good results.
One thing stands out, some nights events were very high. I started to pay attention to what I do differently on those nights.
Two things became clear:
I generally slept much deeper on the nights with high events, drool all over the pillow kind of deep sleep
I took either Ibuprofen or Tramadol on the nights with high events (recovering from broken ribs).

To test my theory I downloaded SleepyHead and looked at three nights data.
First without any pain meds. AHI was 1.03 (0.91 Obstructive, 0.13 Clear) and CSR 0%
Second with Ibuprofen. AHI - 16.05 (3.44 Obstructive, 0.89 Hypopnea, 11.72 Clear) and CSR 9.4%
Third with Tramadol. AHI - 32.25 ( 7.93 Obstructive, 0.55 Hypopnea, 23.78 Clear) and CSR 13.26%

any insight would be great.

Your results are not surprising.

Read everything you can about the medications you take.

https://www.drugs.com/ibuprofen.html

https://www.drugs.com/tramadol.html


Den

.

I take ibuprofen and occasionally tramadol. Never had results like that. I wonder if they are causing you to sleep on your back.

As I'm discovering, AHI is not always a reliable indicator of good therapy. Went over 5.0 last night with some broken sleep but simply bounced out of bed this morning - go figure! Felt good all day with the usual fade at the end of the day but I suppose everyone, OSA or not, has that. Teaching can do that to ya.

Ibuprofen/NSAID's can have adverse affects on sleep quality.

http://www.ncbi.nlm.nih.gov/pubmed/8047572

Aspirin and ibuprofen disrupted sleep in comparison to placebo by increasing the number of awakenings and percentage of time spent in stage wake, and by decreasing sleep efficiency. Ibuprofen also delayed the onset of the deeper stages of sleep. Acetaminophen did not differ significantly from placebo on any measure of polygraphically recorded sleep. However, every index of objective sleep reflected slight, albeit nonsignificant, sleep disruption for each drug group relative to placebo. The mechanisms of sleep disruption after NSAID administration may relate to direct and indirect consequences of inhibiting prostaglandin synthesis, including decreases in prostaglandin D2, suppression of nighttime melatonin levels, and changes in body temperature.

Wulfman... wrote:.

Your results are not surprising.

Read everything you can about the medications you take.

https://www.drugs.com/ibuprofen.html

https://www.drugs.com/tramadol.html

Den

.

Thank you for the links

Holden4th wrote:I take ibuprofen and occasionally tramadol. Never had results like that. I wonder if they are causing you to sleep on your back.

As I'm discovering, AHI is not always a reliable indicator of good therapy. Went over 5.0 last night with some broken sleep but simply bounced out of bed this morning - go figure! Felt good all day with the usual fade at the end of the day but I suppose everyone, OSA or not, has that. Teaching can do that to ya.

I actually sleep on my back nearly all night. I rarely sleep on my side due to the broken ribs.
Is SpO2 a better indication of effective sleep than AHI?

raisedfist wrote:Ibuprofen/NSAID's can have adverse affects on sleep quality.

http://www.ncbi.nlm.nih.gov/pubmed/8047572

Aspirin and ibuprofen disrupted sleep in comparison to placebo by increasing the number of awakenings and percentage of time spent in stage wake, and by decreasing sleep efficiency. Ibuprofen also delayed the onset of the deeper stages of sleep. Acetaminophen did not differ significantly from placebo on any measure of polygraphically recorded sleep. However, every index of objective sleep reflected slight, albeit nonsignificant, sleep disruption for each drug group relative to placebo. The mechanisms of sleep disruption after NSAID administration may relate to direct and indirect consequences of inhibiting prostaglandin synthesis, including decreases in prostaglandin D2, suppression of nighttime melatonin levels, and changes in body temperature.

Thank you for the link and info. I may give Acetaminophen a try.

Back sleeping provokes many more apneas in most people, so even if you're on Cpap it's best to try and side sleep (at least when your ribs are better).

Julie wrote:Back sleeping provokes many more apneas in most people, so even if you're on Cpap it's best to try and side sleep (at least when your ribs are better).

Thank you Julie,
I actually never made that connection.

So I guess the real question is, what are the consequences of so many events. As I mentioned in my first post I am feeling pretty good in the mornings. The majority of the events are clear airway events. There is really not much to do about those (other than not taking the pain meds) right? No amount of forced air will keep those from happening if i understand correctly.

Is it a lack of oxygen? I ordered an SpO2 monitor and hope to get some good data about my levels. What other issues should I watch for?

I did try side sleeping last night with some success, the obstructive events dropped a bit but the clear airway events stayed about the same.

Thanks to all for your insight.

338Baloo wrote:There is really not much to do about those (other than not taking the pain meds) right? No amount of forced air will keep those from happening if i understand correctly.

Correct. No amount of forced air will keep those centrals from happening...at least with your machine.
I wouldn't worry about them at this time. Some of them may be suppressed respiration due to the meds and some of them may be from holding your breath subconsciously due to pain upon respiration from the broken ribs.

You can go to the events tab and then the central/clear airway tab and look at the number in parentheses for duration of event in seconds and if the duration is relatively short it is unlikely that significant drops in oxygen levels happened. Might give you a little peace of mind in that regard.

Pugsy wrote:You can go to the events tab and then the central/clear airway tab and look at the number in parentheses for duration of event in seconds and if the duration is relatively short it is unlikely that significant drops in oxygen levels happened. Might give you a little peace of mind in that regard.

All events are in the 10 to 20 second range. Is that considered relatively short?

Yes...10 to 20 seconds is relatively short.
Hold your breath for 20 seconds...that's easy to do any unlikely to cause any oxygen level drops unless you do it every 60 seconds for 30 minutes or something like that. If you had that pulse oximeter you would see that 20 seconds is unlikely to cause much (if any) drop in O2 levels. It takes a lot longer than that and a whole bunch of them together at that.

Hold your breath for 20 seconds...that would be flagged as a 20 second central/clear airway apnea event.
The airway is open but no air is moving.

I have been there with the broken rib thing and it's not unusual for us to sort of hold our breath to minimize the pain that we have upon respiration. We do it and not realize it. Or we shallow breathe and that causes us to blow off the carbon dioxide too soon and the brain doesn't know that it needs to tell the body to breathe. It's the level of carbon dioxide in the blood stream that is the actual trigger for the brain to send the signal to breathe. It has to be at a higher level and when we shallow breathe we can blow off the carbon dioxide so that it doesn't get to that higher level.
Between the meds maybe suppressing respiration a bit and the tendency to avoid big deep breaths due to pain it's possible that the carbon dioxide just doesn't get high enough for the brain to send the signal to breath.
People tend to think it is oxygen levels that are the trigger for the brain but it's really carbon dioxide.
So with the shallow breathing the brain simply doesn't know that it needs to send the signal.

I wouldn't worry about the centrals at this time. There's a known reasonable explanation for them that should go away once things are healed up and you no longer need the meds and/or have shallow breathing or hold your breath due to the pain.

Pugsy wrote:Yes...10 to 20 seconds is relatively short.
Hold your breath for 20 seconds...that's easy to do any unlikely to cause any oxygen level drops unless you do it every 60 seconds for 30 minutes or something like that. If you had that pulse oximeter you would see that 20 seconds is unlikely to cause much (if any) drop in O2 levels. It takes a lot longer than that and a whole bunch of them together at that.

Hold your breath for 20 seconds...that would be flagged as a 20 second central/clear airway apnea event.
The airway is open but no air is moving.

I have been there with the broken rib thing and it's not unusual for us to sort of hold our breath to minimize the pain that we have upon respiration. We do it and not realize it. Or we shallow breathe and that causes us to blow off the carbon dioxide too soon and the brain doesn't know that it needs to tell the body to breathe. It's the level of carbon dioxide in the blood stream that is the actual trigger for the brain to send the signal to breathe. It has to be at a higher level and when we shallow breathe we can blow off the carbon dioxide so that it doesn't get to that higher level.
Between the meds maybe suppressing respiration a bit and the tendency to avoid big deep breaths due to pain it's possible that the carbon dioxide just doesn't get high enough for the brain to send the signal to breath.
People tend to think it is oxygen levels that are the trigger for the brain but it's really carbon dioxide.
So with the shallow breathing the brain simply doesn't know that it needs to send the signal.

I wouldn't worry about the centrals at this time. There's a known reasonable explanation for them that should go away once things are healed up and you no longer need the meds and/or have shallow breathing or hold your breath due to the pain.

Thank you so much! I believe I will sleep better tonight.

A quick update,
I have the new pulse oximeter. it is a CMS 50F Plus. The first few nights I was reading between 88 and 92%. I then traveled to a lower elevation for a business trip (I live about a mile high). The new place was near sea level. My values were from 92 to 94%. I have an O2 concentrator from the broken ribs incident. I was told while in the hospital that i would probably need it anywhere from the next six months to the rest of my life (yes the ER doctor had a great bedside manner). I quit using it when I started using my CPAP, figured i did not really need the O2 anymore.

I hooked the O2 up to my machine to see if my SpO2 increased. I loaded up on the pain meds as usual. The O2 did as expected. The thing i did not expect was that my events all but disappeared, particularly the clear airway events. Last night was one of the best nights sleep I have had in quite some time. I feel rested and clear headed today. It has taken about 4 nights on O2 for me to start feeling better.

You said: I then traveled to a lower elevation for a business trip (I live about a mile high).

Have you seen this study:
This study documents both the incidence and effects of central apnea on diagnosis and treatment of OSA at different altitudes in the Mountain West and substantiates the clinical impression that individuals living at altitude with moderate to severe OSA are significantly more difficult to treat with PAP.

Source:

The Effects of Altitude Associated Central Apnea on the Diagnosis and Treatment of Obstructive Sleep Apnea: Comparative Data from Three Different Altitude Locations in the Mountain West:


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227706/

i want to thank 338baloo for posting about this. i had NO idea that this was a thing. and additional thanks to wulfman and raisedfist for the links. fantastic stuff.

about a week to ten days ago, i had a record low AHI of 0.24. and really slept well. i was really happy with those results, as you may imagine. i had gone through a week of monitoring my evening snacks and had found that sugar was kicking my AHI up. without sugary snacks. i was able to get it down to that 0.24. yay!

but the next night, my AHI started going up! why? i had found the culprit, how could this happen?

well, i have a history of a bad back. the night after i recorded that low, i hurt my back mowing the grass. and what's my go to pain relief? ibuprofen! i know that ibuprofen has a bad history anyway. wasn't it connected to liver failure? something like that. so i thought i was playing it smart by just taking two a day then using aspirin for the rest of the day!

during this bout of using the pain killers, my AHI got up to 2.0. then i read this post. now that my back has gotten back to normal, i spent the last two nights without them. guess what? my AHI has gotten back down to 0.82. so i'm well on my way.

and i'm sleeping better too with less frequent awakenings in the night.

so yeah, thanks a lot for this thread guys!!

avi123 wrote:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227706/

Thank you for the link, It was very informative.

zonker wrote:i want to thank 338baloo for posting about this.... thanks a lot for this thread guys!!

This is a great group! The wealth of knowledge here is amazing!