Need info on use of CPAP with chronic pain medications

rudyrx · Post by **rudyrx** » Fri Dec 14, 2007 7:06 pm

Anyone else like me find that they are now posed with the the need to be on chronic pain meds, but at the same time know that these medications are not to be used with OSA. I am currently seeing and Pain specialist whom I trust greatly (MD with specialty of Anesthesiology along with chronic pain management.) I am beginning to wonder if the pain medications he has me on daily (morphine time release and vicodin) are adversely affecting the affects of the CPAP, since as you all know they dedcrease respiratory function.
Has anyone else been fced with the same dilema- living with constant pain, also defeating somewhat the purpose of the CPAP or APAP ? Any comments about happenings from others faced with the same situation would be greatly appreciated.
RUDYRX

mindy · Post by **mindy** » Fri Dec 14, 2007 7:17 pm

I don't have the same problem but here's something that did happen to me that might provide a bit of illumination?

I am a chronic insomniac and have been for years. I've been on sleeping meds for about 20 years. Since Ambien came out I've been taking that and I was told and have read that Ambien can make sleep apnea worse because it relaxes the muscles in the air passages. As a result, I may have needed a higher pressure on CPAP than I would have without the medication.

Pain medications can have similar effects so it's very possible that, if anything, you might have more of a need for CPAP than otherwise. Best to make sure your doctor is on board, though!

Mindy

rudyrx · Post by **rudyrx** » Fri Dec 14, 2007 7:41 pm

Mindy,
Thanks for the thought. I see my pain doctor next week and I will discuss it with him. Your reasoning in regards to Ambien is sound and makes sense to me, but I will run it by him before I reset my upper and lower limits on my APAP.
Thanks
Rudyrx

Perchancetodream · Post by **Perchancetodream** » Fri Dec 14, 2007 7:44 pm

It would probably be a good idea to have another titration done while you are on the pain meds. Are you able to read the data from your machine? You may need to increase your max pressure if you are using the APAP feature of your machine, but in your situation, you should have professional advice.

[As a cautionary tale, my best friend is coming home tomorrow after going through a drug detox program. She was prescribed the same drug combo by a reputable physician specializing in pain management. After three years she had a seizure while out of state; the ensuing hospital stay revealed heart and lung damage attributable to her drug use.

Having suffered from chronic migraines, I appreciate that a life spent in pain is hardly worth living. I was lucky, stopping Premarin stopped the migraines. Hope that your outcome is good.]

Susan

ozij · Post by **ozij** » Fri Dec 14, 2007 10:22 pm

Look for posts by dllfo.

O.

zorrro13 · Post by **zorrro13** » Fri Dec 14, 2007 10:32 pm

The primary function of Apap is to keep the airway open and it should keep the airway open regardless of alcohol or drug intake and it will make the necessary changes automatically. As far as I understand it relaxants are a big no no if you don't have a machine. I think you will be OK but its a bummer to have to deal with it along with chronic pain. Good luck

kteague · Post by **kteague** » Fri Dec 14, 2007 11:30 pm

The two suggestions of either get titrated while on the meds or use an autopap that will adjust to changing pressure needs sound good to discuss with the doctor at your upcoming visit.

I have a question though for anyone who is in the know - It seems I read somewhere on here that some meds affect apnea not by relaxing the throat muscles, but by suppressing the part in the brain that controls breathing (same as causes central sleep apnea). If that were the case, would an increase in pressure potentially cause more of a problem? Just thinking "out loud".

Kathy

mindy · Post by **mindy** » Sat Dec 15, 2007 10:46 am

Kathy,

I had heard the throat relaxation was the reason but certainly can't say for sure! When I had my titration we discussed Ambien dosage in relation to that. In any case, I wouldn't make any therapy changes based on that without a doc's ok.

Mindy

ozij · Post by **ozij** » Sat Dec 15, 2007 10:58 am

posting.php?mode=reply&t=26765

Sleep Apnea Often Seen With Chronic Opioid Use

September 21, 2007 — Sleep-disordered breathing is very common in patients who use opioids for chronic pain conditions, according to a report issued online September 6th by the journal Pain Medicine.

"Sleep disturbances are common in people with chronic pain, but relatively little research has been performed to investigate the effects of long-term opioid therapy on sleep," lead author Dr. Lynn R. Webster, from Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah, told Reuters Health.

For their study, Dr. Webster and colleagues offered polysomnographic testing to 392 consecutive patients who were visiting a private clinic for control of chronic pain. The subjects had been receiving around-the-clock opioids for 6 months or longer with no change in the dose for at least 4 weeks.

Of the 147 patients who agreed to undergo testing, 140 had data available for analysis, the report indicates.

The median daily dosage of all opioids was 266 mg of morphine equivalents, and "in the 36% of patients taking benzodiazepines, the median daily dosage in diazepam equivalents was 15 mg," the team reports.

"The biggest finding was an extraordinarily high prevalence of sleep-disordered breathing in opioid-treated chronic pain patients," Dr. Webster noted. "Obstructive and central sleep apnea syndromes occurred in the studied population at a far greater rate (75%) than is observed in the general population."

The most common type of sleep apnea, seen in 39% of all patients, was the obstructive type, followed by central sleep apnea in 24%, central and obstructive sleep apnea in 8%, and indeterminate type in 4%.

The apnea-hypopnea index was directly related to the daily dosage of methadone, but not to that of other opioids (p = 0.002). The central apnea index was directly linked to the daily dosage of both methadone (p = 0.008) and benzodiazepines (p = 0.004).

"Tolerance to the respiratory effects of opioids is often assumed to be complete in patients on long-term opioid therapy. This research adds to a growing body of literature suggesting this may not be true for all patients," Dr. Webster pointed out.

He said that further studies are needed to clarify how various opioids influence the risk of sleep apnea and why methadone, in particular, may have a greater effect.

Meanwhile, Dr. Webster and colleagues conclude: "The challenge is to monitor and adjust medications for maximum safety, not to eliminate them at the expense of pain management."

Pain Med. Published online September 6, 2007.

mindy · Post by **mindy** » Sat Dec 15, 2007 11:09 am

Thanks, Ozij!

One of the things I love about this forum is the amount of collective knowledge and the speed with which helpful info appears

Mindy

ozij · Post by **ozij** » Sat Dec 15, 2007 11:17 am

I love this forum too.

O.

rudyrx · Post by **rudyrx** » Sat Dec 15, 2007 2:34 pm

THANKS EVERYONE FOR THE EXCELLENT INPUT ON MY QUESTION. I HAVE BEEN ON CHRONIC PAIN MEDS DUE TO A BOATING ACCIDENT FOR ABOUT 3 YEARS AND HAVE HAD SLEEP APNEA FOR 20+ YEARS PRIOR TO THIS. I STARTED FEELING TERRIBLE WITH NO ENERGY ETC, JUST LIKE THE OLD DAYS BEFORE CPAP (NOW AN APAP) AND BEGAN TO WONDER IF THE MEDS WOULD INPACT THE LEVEL OF SLEEP QUALITY THAT MUCH. (YOU WOULD THINK THAT I WOULD HAVE FIGURED THIS OUT MUCH SOONER SINCE I AM A PHARMACIST --DUH!! BUT IT SNEAKS UP ON YOU SLOWLY AND THE "FOG" SLOWLY IMPAIRS YOUR CONCENTRATION AND THINKING AS WE ALL KNOW)
I APPRECIATE ALL OF YOUR IN IDEAS AND WILL TALK TO MY DOC ABOUT THIS ON WEDS 19TH AND WILL GIVE YOU HIS FEEDBACK IN CASE IT WILL BE OF HELP TO OTHERS.
AFTER 2 SURGERIES FOR APNEA, I JUST HATE THE IDEA OF GOING THROUGH ANOTHER DREADED SLEEP STUDY FOR THE 10+ TIME. THEY ARE SO UNREALISTIC TO REAL LIFE SLEEPING AND FEEL THEY DO NOT GIVE AN ACCURATE VIEW-JUST MY THOUGHTS.
THANKS TO YOU ALL AGAIN
RUDYRX

Perchancetodream · Post by **Perchancetodream** » Sat Dec 15, 2007 3:04 pm

Perhaps your doc can set you up with an at-home titration with O2 Sat measurements.

mindy · Post by **mindy** » Sat Dec 15, 2007 3:24 pm

Good luck, RudyRx!

I hope you can get back to feeling better soon.

M

krousseau · Post by **krousseau** » Sat Dec 15, 2007 4:35 pm

As already mentioned you may need a higher pressure-also OSA is a progressive condition and you may need a higher pressure on the basis alone. You also have a lot of things going on that can affect your sense of well being and energy.
You are under medical supervision. Listen to your body-talk wiith the doc about any adverse effects you notice. Some people who have had bad effects from medications ignored early signs of problems, some have an unpredictable response to a medication-so pay attention to your body-you know it best. Knowing a drug is 99% safe doesn't do you a bit of good if you are in the 1% that reacts. Developing tolerance to narcotics is not addiction in my mind. And don't stop drugs without medical supervision-don't let yourself run out of meds. Your body does get to rely on some medications and responds poorly to not having the med. My blood pressure shoots up if I forget to take my BP med-does that mean that I'm addicted to it? To me addiction occurs when someone takes a narcotic to deal with feelings, get a high, or knock themselves out---escape. Relief of pain is a good reason to take pain meds. The other suggestion is to use all means to relieve pain; relaxation, TENS, imagery.

Need info on use of CPAP with chronic pain medications

Need info on use of CPAP with chronic pain medications

Pain meds and CPAP