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EricinNC wrote:

mstevens wrote:

EricinNC wrote:It is well established in medical literature that taking benzos longterm leads to physical addiction, dependence, whatever you wish to call it.

What I "wish to call it" depends on what it is, since "physical addiction" does not exist and since addiction and dependence are different things.

Anyway to put someone here on ignore?

Eric

I think mstevens is wasting his time. There are none so blind as those who will not see.

Eric, click on the poster's name, then click on "add foe". You may as well "foe" me, too, while you're at it.

M.D.Hosehead wrote: I think mstevens is wasting his time.

I honestly don't think so... Other readers will now be able to find mstevens' clear explanation of medical "dependence" vs "addiction". We also have the option now of quoting some of that text the next time a newcomer posts worries about becoming "addicted" to CPAP.

So kudos to mstevens for explaining all that to an audience that is much larger than one person.

mstevens wrote: Where you are getting tripped up is in terminology, which in medicine is pretty important. Dependence and addiction are different things.

That's the problem. They may be different things - but many Dr's don't really think about the consequences if someone is not an addict. Actually most Dr's don't think about that at all.

So you have Dr's prescribing totally legitimate medicines with huge physiological dependency issues. In trying to help one problem, they end up making a bigger problem. Now much of this is because people generally take their physicians to be correct all the time - something that is rarely, if ever true.

Addiction is important to Dr's because they are legally liable for not preventing it - if the patient is a potential addict. Physical dependence is not a problem to them because they are not liable for what is determined to be "normal medical practice". Of course, it matters a whole lot to the rest of us - but we aren't nearly as important to prevent the feeding an addict!

So we have Dr's routinely under medicating pain patients taking on the attitude that the less that is given to people the better. Even more sick than that is that they still tend to give less than adequate pain medicines to dying patients. We wouldn't want Charlie to die while dependent on Morphine would we? On the flip side, they will give lots of medicines that form physiological dependences because they are not responsible for the end result. Klonopin for sleep - no problem - Suzy isn't an addict! Oh, she can't get off the medicine? That's odd!

So "addiction" and "dependence" are critically important to Dr's for all the wrong reasons. They give so much power to the addicts that they let the addicts rule what is "normal medical practice". The rest of us are let to get miserable because the Dr's can't prioritize what is critical to us - not them. And no - I have never personally nor heard of anyone be told that they are being given a medicine with high potential for physiological dependence.

I disagree with some that this discussion is irrelevant. As I said earlier I know of tons of people waling around "tired" all day not understanding that it is likely the 4mg of Klonopin they take every night.

-SWS wrote:

M.D.Hosehead wrote: I think mstevens is wasting his time.

I honestly don't think so... Other readers will now be able to find mstevens' clear explanation of medical "dependence" vs "addiction". We also have the option now of quoting some of that text the next time a newcomer posts worries about becoming "addicted" to CPAP.

So kudos to mstevens for explaining all that to an audience that is much larger than one person.

You have a good point.

Take 2 to 4 mg klonopin or any other benzo for ten years and see if you dont get dependent/addicted physically to it. Go ahead, be my guest. Try it. See what happens.

Eric

BrianinTN wrote:I've read that benzos (such as klonopin/clonazepam) can exacerbate sleep apnea. My question is: for those of you with some experience here, by how much?

Background: In my sleep studies last summer, despite taking Lunesta in one and Ambien in the other, I couldn't settle down at all. So, for my third and latest study a few weeks ago, I added 0.25 mg of clonazepam to a bedtime Lunesta. Because my prescribed pressures (20/16 BIPAP) came back significantly higher than they had been set at in a study just 9 months prior (13 CPAP), I'm wondering if my meds contributed to my situation at all.

Most of what I've read hasn't been terribly quantitative, so I'm hoping some of you might be able to weigh in and offer an opinion. Such a small amount of clonazepam seems like it would have little to no impact, but what do I know? Thanks!

BrianinTN wrote: ... In my OP, you'll see that I referenced a dose of 0.5mg.
...
My major question remains -- what is the effect of occasional and very mild use of a benzo on a sleep study, and to what extent would it affect results *especially* in a titration study? So far I haven't seen anyone suggesting this is a big deal.

Oh, back to that.

I don't think it can be known whether the small dose (.25 mg) of clonazepam you took with your second titration study was the primary reason for a much higher titration. However, my suspicions are that it was not a significant factor.

I suspect that the difference in titration results is more likely due to:

1) The fact that we may sleep/breathe differently every night due to all the factors of sleep hygiene - what and how much was eaten during the day at what times; how much emotional stress was experienced; level of physical activity during the day; mental attitude toward the sleep study; etc. Every day is different and that makes the two nights and two titration studies different.

2) The approach the technicians took may have differed over the two nights.

3) When there are big differences in prescribed titration pressures, positional sleep apnea should also be considered as a possible cause - viewtopic/t40307/viewtopic.php?f=1&t=40 ... 94#p352594

Not having much confidence in the ability of anyone to find the optimal titration in a one-night sleep study, I would try to find the optimal pressure using the tools (ResScan software) you have, experimenting, and making and recording detailed observations.

Thanks Roster. That all makes sense. Whenever I get my currently-garbage data stabilized, I'll probably try and do a home experiment of my own to see whether there is an effect from a small amount of klonopin on me. Like you, I'm skeptical, but I'll be sure to post my results in this thread.

I think klonopin helps a lot and there's an article in Sleep showing it reduces centrals. I also took 2 restoril before a sleep study and it helped the results but on the MSLT I failed the day after and had a lot of narcolepsy. but somehow klonopin is more effective than restoril or ambien.
does anyone else have a better drug? I tried sonata too but it doesn't seem to help.

sickwithapnea17 wrote:I think klonopin helps a lot and there's an article in Sleep showing it reduces centrals. I also took 2 restoril before a sleep study and it helped the results but on the MSLT I failed the day after and had a lot of narcolepsy. but somehow klonopin is more effective than restoril or ambien.
does anyone else have a better drug? I tried sonata too but it doesn't seem to help.

Wow, way to bring back an old thread—and me with it. Um, you could try seroquel. I was on it for a while. I ended up hating it (it became really hard to sleep when not taking it, and that took a while to get over), but it's pretty sedating and, in the research I did, there didn't seem to be evidence suggesting it worsened apneas. On the plus side, it's supposed to increase REM sleep whereas benzos can do the opposite. I'll let someone with more medical knowledge on the impacts on sleep architecture comment on the accuracy of that.

I think klonopin is a great sleep medication, I feel much better on it and have less centrals, in fact my centrals seem to

SW17 or whoever you want to be....you need help from your medical care team.
Drug cocktails aren't advisable unless under a close doctor's supervision for any reason with the class of drugs you are taking willy nilly. While they are at it perhaps another blood serum acorn level evaluation is needed.

BrianinTN, please be aware that SWA/Dying appears to be a patient that is fishing for affirmation. He/she complains about feeling constantly foggy. We've mentioned this could well be due to the Klonopin this patient is taking. Seroquel may be an option. But that's for a doctor who KNOWS this patient to decide.

Anytime this patient provides graphs and/or data it indicates the apnea is being addressed by the ASV therapy. Perfectly, perhaps not. But ASV therapy takes time and consistency to be effective.

Instead the nickname of this patient is rather telling: Sick With Apnea ... Dying .... While I am one of the first to admit that apnea is a serious chronic condition, it really does not warrant such theatrics. As with most chronic conditions, proper and consistent treatment can allow the sufferer to lead a very productive life. However, that requires a willingness to see the glass as half full.

Due to all of this, we continue to advise this patient to work with their doctor to improve their sleep. Using our own experience as a guide, we attempt to provide common sense approaches that we work. Typically this patient goes away and comes back in a week or so, once again hunting for affirmation. There is simply nothing much further we can do as a forum. Thus, we raise a constant, but polite refrain ... Work with your doctor.

Ah, I'll return to my regularly scheduled program then. Good to see you guys, and hope you're all doing well!

BrianinTN wrote:Ah, I'll return to my regularly scheduled program then. Good to see you guys, and hope you're all doing well!

Ditto! If I remember you were busy with your studies. I hope that continues to go well for you.

Just read through this old thread for the first time and have a couple of comments. Clonazepam and other benzos may well make your sleep apnea worse but if the option is to not sleep during the sleep study then there's not much choice. If you come home with a pressure rating higher than really needed you can self-titrate down to the optimum level. As for the addiction/dependency issue, hair-splitting on the terminology isn't of much interest to anyone who has been prescribed a benzo and can't get off it because of the withdrawal symptoms, sometimes protracted, that afflict some users even after only a short course of treatment. This is a real problem, well described in the inserts that come with these drugs, and is one reason for the restrictions on their use. Many doctors are apparently not aware of these problems and will prescribe these drugs in situations where other treatment options exist. In any case, you may not be told of the dangers by your prescribing doctor or even a psychiatrist. Benzos have their uses in the treatment of severe anxiety and seizures and for conscious sedation but long term use for any reason will result in accidental addiction/dependency in many people. Be aware of the dangers if you start using these drugs, or any of the very similar hypnotic z-drugs (Ambien, Lunesta etc.) to help you sleep. As hard as it is, non-drug strategies may be preferable to get through periods of insomnia.

JMO.