No Answers Yet For Problems With ASV

NotMuffy wrote:

Paper_Nanny wrote:MSD and my neurologist both concluded that drug effect was not an issue.

OTOH, I suppose it depends what your definition of "issue" is.

They said medication was not a contributing factor to the sleep apnea, or to the delayed onset REM. Could be true... Might depend on what are their definitions of "not a contributing factor"

I had a sleep study done in 2006. The comment section said, "The patient does not have evidence of any disturbance of her sleep. Her sleep architecture is abnormal in that she has absence of delta sleep and a reduced amount of rapid eye movement sleep and delayed rapid eye movement sleep onset.

It is possible that her intrathecal Baclofen, oral Baclofen, Zanaflex, Klonopin, Trazadone, and to a lesser extent Tegretol contribute to reduced sensorium and excessive sleepiness during the day. It is also possible that Depression would contribute to excessive somnolence. The results of this study will be reviewed with her in the office."

The summary of my follow up visit included the statement "In reviewing her complaint it is clear that she is on five different medications that could be associated with fatigue and somnolence in addition to multiple sclerosis affecting her sleep architecture and increasing her likelihood of fatigue."

NotMuffy wrote:

Paper_Nanny wrote:Yes, I do have a medication list and timeline from back when both studies were done. I will post it if that would be helpful to you.

Can't hurt. I think that's the next logical place to search for an explanation.

Here is a list of the medications I take. Same ones I have been on for quite awhile now. List does not include over the counter medications taken prn.

Copaxone
1 SQ injection daily
Taken for MS disease modification

Cymbalta 60 mg
1 capsule 2 times daily
Taken for depression, fatigue, and pain

Fexofenadine 180 mg
1 tablet daily
Taken for allergies

Flexeril 5 mg
½ tablet at bedtime
Taken for fibromyalgia related sleep disruption

Intrathecal Baclofen
360.2 µg per day
Taken for spasticity
Basal rate= 11.3 µg/ hour; 50.0 µg bolus at 0630 and at 2200; total daily dose= 360.2.

Klonopin 0.5 mg
1 tablet at bedtime
Taken for muscle spasms

Lisinopril 10 mg
1 tablet per day
Taken for hypertension

Methylin 5 mg
1- 2 tablets in the afternoon
Taken for fatigue

Methylin ER 10 mg
1 tablet in the morning
Taken for fatigue

Neurontin 600 mg
2 tablets 3 times per day
Taken for pain

Provigil 200 mg
½- 1 tablet 2 times per day
Taken for fatigue

Soma 350 mg
1 tablet every 6 hours
Maximum of 2 in 24 hours
Taken as needed for muscle spasms
(I usually take this less than once every other week, almost always limited to half a tablet)

Trazodone 100 mg
1 tablet at bedtime
Taken for sleep disrupting central auditory processing disorder

Testosterone 0.5% gel
0.5 ml (2.5 mg) daily
Taken for hormone deficiency

Ultram 50 mg
1- 2 tablets every 6 hours
Up to 4 tablets per day
Taken as needed for pain

Zanaflex 4 mg
1 tablet at bedtime
Additional 1- 2 tablets up to 3 times a day as needed
Taken for spasticity
(I do not often take any during the day. Sometimes take one during the night if I am exceptionally spazzy that night.)

Supplements:
Acidophilus
Calcium
Essential Fatty Acids
Magnesium
Multivitamin
Vitamin D
Vitamin E

Broken down by time. Supplements excluded. I can provide times for those if need be. Copaxone and testosterone excluded because there is no set time when I do those.

First thing in the morning:
Cymbalta, Lisinopril, Methylin ER, Neurontin, Provigil

Between 1230 and 1400:
Methylin, Neurontin, Provigil

At bedtime: (within half an hour of when I get in bed to sleep)
Cymbalta, Fexofenadine, Flexeril, Klonopin, Neurontin, Trazodone, Ultram, Zanaflex

edit to correct intrathecal baclofen dose information

NotMuffy wrote:Your sleep architecture shows 75% of your REM periods missing with severely prolonged REM Latency:

About the only way you can do that trick is with REM-suppressant medications (like SSRIs).

Trazadone. Cymbalta. Problem will be trying to find alternative medications. I hate that part.

Paper_Nanny wrote: Here is a list of the medications I take. Same ones I have been on for quite awhile now. List does not include over the counter medications taken prn.

Downing all those pills must cut into your computer time?

Paper_Nanny wrote:

NotMuffy wrote:Your sleep architecture shows 75% of your REM periods missing with severely prolonged REM Latency:

About the only way you can do that trick is with REM-suppressant medications (like SSRIs).

Trazadone. Cymbalta.

And Klonopin.

Paper_Nanny wrote:Problem will be trying to find alternative medications.

Why do you want to do that?

I have a question.

When you go to the pharmacy, do they run your list of medications through the automatic drug interaction checker?

Anyway, in relation to the SDB issues, with clonazepam, baclofen, carisoprodol, cyclobenzaprine, trazodone and tramadol all having sedative properties, the first thing I would look for is if you've moved out of "sedation" into "chronic respiratory depression". The elevated CO2 (while it could have been metabolic) now appears to be respiratory, and an ABG may be in order (what you really needed to do was monitor ETCO2 during the NPSG, but that ship has sailed). If your PFT is normal, then the respiratory depression (if present) is central.

Got headaches?

OTOH, you got methylphenidate and modafinil that may counteract some of the sedative properties. OK that's cool, except they may also create sleep disruption, and your DLs are not reflecting respiratory events but rather sleep disruption. The timeline I was referring to was in relation to the sleep studies (were you taking all that stuff during NPSG, or were one or more added since then). The NPSGs don't appear to have a lot of sleep fragmentation, however (aside from maybe a few too many awakenings).

BTW, I'd also check with the pharmacist about the modafinil-tizanidine and trazodone-methylphenidate combos. There may be some metabolism things you might not want there.

Another Note To Self: Consider altered apnea and arousal thresholds.

StillAnotherGuess wrote:Downing all those pills must cut into your computer time?

Nah, I just put them in a bowl and snack on them as I work on the computer, much the way other people do with chips, candies, and whatnot. The pills have the advantage of being lower calorie than other snacks, plus they don't leave any crumbs or residual stickiness on the keyboard.

Deborah

NotMuffy wrote:When you go to the pharmacy, do they run your list of medications through the automatic drug interaction checker?

Pharmacist said they do, but what that means depends on how they interpret, "run the list of medications through the automatic drug interaction checker." Also, when she said yes, that didn't say anything about what happens to the information generated by doing that.

I have been given warnings about the potential for excessive sleepiness and do not operate heavy machinery until I know how the drug will effect me.

NotMuffy wrote:If your PFT is normal, then the respiratory depression (if present) is central.

I'll wait until the PFT results come back to think about that one. I think I am doing too much thinking ahead in a bad way with some of the SDB stuff, so I'll hold off on this particular point until it is a definite concern.

NotMuffy wrote:Got headaches?

Nope. Got milk?

NotMuffy wrote:The timeline I was referring to was in relation to the sleep studies (were you taking all that stuff during NPSG, or were one or more added since then).

Meh. Had I known that, I would have answered with a more concise, "This is what I am taking now, same as what I was taking then. Only difference, which is a difference across days, is how much of the prn medications I take."

NotMuffy wrote:BTW, I'd also check with the pharmacist about the modafinil-tizanidine and trazodone-methylphenidate combos.

Called shortly after reading your post. She'll get back to me.

I appreciate the help you're giving me, NotMuffy. Appreciate it a whole lot.

Deborah

NotMuffy wrote:

Paper_Nanny wrote:

NotMuffy wrote:Your sleep architecture shows 75% of your REM periods missing with severely prolonged REM Latency:

About the only way you can do that trick is with REM-suppressant medications (like SSRIs).

Trazadone. Cymbalta.

And Klonopin.

Oh, no!! Not my little yellow yums!! I had no idea even they were suspect!! Please!! Say it isn't so!

NotMuffy wrote:

Paper_Nanny wrote:Problem will be trying to find alternative medications.

Why do you want to do that?

I don't. I was thinking ahead in an unproductive way when I said that. I was thinking that if my current medication regimine is causing serious sleep problems, I will have to find alternate medications which treat my symptoms as effectively, without adversly affecting my sleep

A couple graphs, because they are so colourful!

Paper_Nanny wrote:

NotMuffy wrote:

Paper_Nanny wrote:Problem will be trying to find alternative medications.

Why do you want to do that?

I don't. I was thinking ahead in an unproductive way when I said that. I was thinking that if my current medication regimine is causing serious sleep problems, I will have to find alternate medications which treat my symptoms as effectively, without adversly affecting my sleep

Well, I think we're still in the "figuring out" stage. For instance, the point of the "what are you fixing"-- are you sleepy, have weakness, or are fatigued? I see like 6 "fatigues" up there, and xPAP does not fix fatigue, it fixes sleepy. Anyway, your sleep in the diagnostic looks good (OK, maybe REM is a little naked. But there's 30 million people out there with drug-suppressed REM).

Actually, the sleep quality looks better than it should be. If someone is on a methylphenidate-modafinil- hefty duloxetine cocktail, and has fibromyalgia to boot, I thinking "Here comes a train wreck sleep architecture!" Yet, nothin'! Is that because of the clonazepam, baclofen, carisoprodol, cyclobenzaprine, trazodone and tramadol? Get a little high, get a little low, get a little sideways?

NotMuffy wrote:Get a little high, get a little low, get a little sideways?

Paper-Nanny would make Michael Jackson look like he just fell off the turnip truck?

Paper_Nanny wrote:

NotMuffy wrote:Got headaches?

Nope. Got milk?

Course.

I'm a "baked goods".

Paper_Nanny wrote:

NotMuffy wrote:

Paper_Nanny wrote:

NotMuffy wrote:Your sleep architecture shows 75% of your REM periods missing with severely prolonged REM Latency:

About the only way you can do that trick is with REM-suppressant medications (like SSRIs).

Trazadone. Cymbalta.

Comments:

I would be very careful withdrawing from SSRI. I been taking 10 mg of Paxil, which belongs to same family, for 2 decades , and can't withdraw easily from it. I don't think that it delays my REMs.

As to other drugs that are from the nonbenzodiazepines, also called benzodiazepine-like drugs, family such as Zolpidem, well, they were found to help with central apnea.

see this:


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


But overall, being a drug junkie causes acquiring a Central Sleep Apnea syndrome by its own.

See this:


Causes of Central Sleep Apnea syndrome

By Mayo Clinic staff

Central sleep apnea occurs when your brain fails to transmit signals to your breathing muscles. Central sleep apnea can be caused by a number of conditions that affect the ability of your brainstem — which links your brain to your spinal cord and controls many functions such as heart rate and breathing — to control your breathing. The cause varies with the type of central sleep apnea you have.

Types include:

=>Idiopathic central sleep apnea. The cause of this uncommon type of central sleep apnea isn't known. It results in repeated pauses in breathing effort and airflow.


=>Cheyne-Stokes breathing. This type of central sleep apnea is most commonly associated with congestive heart failure or stroke and is characterized by a periodic, rhythmic, gradual increase and then decrease in breathing effort and airflow. During the weakest breathing effort, a total lack of airflow (central sleep apnea) can occur.


=>Medical condition-induced central sleep apnea. In addition to congestive heart failure and stroke, several medical conditions may give rise to central sleep apnea. Any damage to the brainstem — which controls breathing — may impair the normal breathing process.

=>Drug-induced apnea. Taking certain medications such as opioids — for example, morphine, oxycodone or codeine — may cause your breathing to become irregular, to increase and decrease in a regular pattern, or to stop completely.

=>High-altitude periodic breathing. A Cheyne-Stokes breathing pattern may occur if you're acutely exposed to a high-enough altitude, such as an altitude greater than 15,000 feet (about 4,500 meters). The change in oxygen at this altitude is the reason for the alternating rapid breathing (hyperventilation) and underbreathing.

=>Complex sleep apnea. Some people with obstructive sleep apnea develop central sleep apnea while on treatment with continuous positive airway pressure (CPAP). This is known as complex sleep apnea because it is a combination of obstructive and central sleep apneas.

I was thinking that if my current medication regimine is causing serious sleep problems, I will have to find alternate medications which treat my symptoms as effectively, without adversly affecting my sleep


Well, this might take you years.

I have another question.

How long have you been using FitLife TFM?