How do you feel about taking Valium with CPAP therapy?

jwerley · Post by **jwerley** » Wed Jul 25, 2012 12:50 pm

I have been taking 10mg. of Valium (at night only) for many years( 25).....from spinal injuries and surgeries from an auto accident. Recently my doctor retired and I had to find a new doc. She does not want to continue giving this to me because she is afraid of respiratory failure. This is the only drug I take besides my thyroid med. I have to sleep in one position (on my back) because of pain...so the valium helps me with the muscle spasms, stiffness and pain.....plus no side effects. I told her that I am 100% compliant with my c-pap machine and that should mitigate that problem....no dice she says no.

I am just curious as to what some of you think about this.....

chunkyfrog · Post by **chunkyfrog** » Wed Jul 25, 2012 12:58 pm

Will this doc offer an alternative? CNS depressants can be a danger.
If your pain can be managed with a safer drug, I would encourage you to try it.
If your doc thinks you should 'live with' the pain, say good-bye to her.

greatunclebill · Post by **greatunclebill** » Wed Jul 25, 2012 12:58 pm

i think the doctor knows your particular medical history and should be the one to decide about you.

kaiasgram · Post by **kaiasgram** » Wed Jul 25, 2012 1:31 pm

greatunclebill wrote:i think the doctor knows your particular medical history and should be the one to decide about you.

I understand what you're saying, Uncle Bill, but now she's got two different doctors (the new and the recently retired) who both know her medical history and apparently have very different ideas about what is best for her. Seems she is the one who will have to decide, stay with this new doctor and try her recommendations, find another doctor who is willing to go with what has been working for her, or get another opinion from another doctor. (I know benzo meds like valium are a hot button topic but I'm hoping not to stir anything up here.)

jwerley, if you do decide to work with this new doctor I hope any switches in meds will be done slowly and gently, as your body is no doubt very adapted to the valium and would need time to adapt to going off of it.

Best wishes

lazer · Post by **lazer** » Wed Jul 25, 2012 1:47 pm

kaiasgram wrote:... as your body is no doubt very adapted to the valium and would need time to adapt to going off of it. ...

This being my thoughts and of most concern. ^^^^^^^

5thumbs · Post by **5thumbs** » Wed Jul 25, 2012 2:26 pm

a suggestion would be to work out a plan with your new doctor to slowly get the nightly dose lowered. Once you can define the lowest dose (perhaps none), then you can think about substitute medications. Good luck

old64mb · Post by **old64mb** » Wed Jul 25, 2012 2:48 pm

jwerley wrote:I have been taking 10mg. of Valium (at night only) for many years( 25).....from spinal injuries and surgeries from an auto accident. Recently my doctor retired and I had to find a new doc. She does not want to continue giving this to me because she is afraid of respiratory failure. This is the only drug I take besides my thyroid med. I have to sleep in one position (on my back) because of pain...so the valium helps me with the muscle spasms, stiffness and pain.....plus no side effects.

She's probably right (even if for maybe the wrong reasons), but it's a good question as to what to do about it.

On its own, diazepam isn't likely to cause you major respiratory problems, but all it takes is a small interaction with something else - a single glass of alcohol - and you do end up with a decent shot at respiratory failure.

What's very important for you to be aware of, though, is that your assumption is wrong. If respiratory failure happens, a CPAP or BiPAP is -NOT- going to help because they don't actually convince your brain to take a breath. If it's minor, something with a backup breathing rate (the ST or SV models) might help, but I wouldn't stake my life on it. More likely, though, you'd actually need a full on ventilator.

The bigger question is why exactly your old doc left you on a fairly strong benzo for 25 years, and your new doc is correct in trying to find an alternative. Other drugs have become available that might treat you with less potential side effects, and by now you're more than physically addicted to the diazepam.

The key for the new doc is to navigate a tricky maze here - she's both got to find something to you that will deal with your pain so you can sleep effectively, but also respect that it is going to take some work for your body to get off what you're on. Your job is to make sure she does both and to fully cooperate, because she's right trying to get you off of it. It's going to be a pain, but it's something you should be doing.

On the other hand, if she doesn't come up with a plan for both, then it's time to find a new new doc.

Let us know how it works out.

jnk · Post by **jnk** » Wed Jul 25, 2012 3:27 pm

I've heard it said that 'Valium is nothing to get overly excited about.'

DoriC · Post by **DoriC** » Wed Jul 25, 2012 5:50 pm

The literature says that Valium suppresses REM sleep, I'm not sure in all cases but your new Dr may have concerns about that along with OSA.

AHI15 · Post by **AHI15** » Wed Jul 25, 2012 6:32 pm

Abruptly stopping the Valium may be dangerous, as benzodiazepines cause physical dependence and in severe cases of addiction, a potentially fatal withdrawal syndrome.

http://en.wikipedia.org/wiki/Benzodiaze ... l_syndrome

Please understand that I am not implying that you are an addict. Being an addict and being physically dependent are two different things. If you have been on Valium daily as directed by a doctor for 25 yrs. then your body is most likely dependent, meaning withdrawal symptoms may set in if the drug is abruptly discontinued.

Thus, I sure hope you have 1. a supply of 10mg Valium to keep stable until you decide what to do; 2. the new doc. understands that she can't just abruptly cut you off.

If the new doc. does simply cut you off then she's as questionably competent as the doc. that let you take Valium for 25 years straight in the first place.

Please be very careful and if you decide to go off the Valium, get competent help to ramp down the doses slowly so you aren't endangered by the process.

Good luck.

ems · Post by **ems** » Wed Jul 25, 2012 11:36 pm

Why your old doctor kept you on 10 mg Valium is no longer relevant.

What's important now is that your new doctor realize she can't allow you to go cold turkey off the Valium. You need to taper very slowly off any Benzo. If she doesn't get this, please go to another doctor who takes Benzo withdrawal seriously.

She also needs to work with you to see what would work for you and help you sleep. A sleep specialist might be in order here.

jwerley · Post by **jwerley** » Thu Jul 26, 2012 12:06 am

Thanks to all....Your advise will be taken seriously and tapering off will be done responsibly.... in light of the fact that Valium can interfere with Rem sleep....as well as other side effects, especially as we get older.

Janice

lazer · Post by **lazer** » Thu Jul 26, 2012 8:09 am

This may be somewhat relevant and then again maybe not in your case since you are taking the Valium more for "pain" , however it got me thinking about a similar drug which I've been on for quite some time (Xanax) for treating anxiety and insomnia. According to the following, the xanax may be adversely effecting "sleep stages" and specifically REM and Deep Sleep and of which the Valium is mentioned in the same way further down this article:

Firstly, not to be disrespectful but anyone who says "zanny" is not a good source of information.

There are two major issues of sleep 1) sleep time 2) sleep quality. They are NOT the same thing. When I say "quality" I mean like comparing a large "box" of wine to a 6 litre bottle of 1998 Chateau Lafite-Rothschild Pauillac (about $6,000USD).

Sleep time is certainly important and people typically need between 7-9hrs of sleep. There are people can do well with 5hrs and some need 10hrs.
By age:
Ages 3 to 6: between 10 and 12 hours of sleep
Ages 6 to 9: about 10 hours of sleep
Ages 9 to 19: about 9 hours of sleep
Adult: about 8hrs of sleep
Elderly: between 7 and 8 hours of sleep (typically with naps)

Then there is quality, which is far more important. When we sleep it is not the same, there are four stages of sleep N1, N2, N3, and REM (rapid eye movement, when we dream). N1-N3 are collectively known as non-REM (NREM) sleep. There used to a stage N4 but it was merged with N3.

Stage 1 (N1): lasts five or ten minutes. Eyes move slowly under the eyelids, muscle activity slows down, and people easily awakened and do not relise they have been asleep. Alpha waves transition to theta waves.

Stage 2 (N2): eye movements stop, heart rate slows, and body temperature decreases. Sleep spindles (sigma waves) and K-complexes appear.

Stages 3: people are difficult to awaken, if awakened, people have a hard time adjusting and often feel groggy and disoriented for several minutes or hours. Deep sleep is highly restorative and helps replenish the energy used when awake. Blood flow decreases to the brain and redirects itself towards the muscles, restoring physical energy. Typically parasomnias like sleep walking occur in this stage. Most effects of sleep deprivation are due to not getting N3 sleep.

REM sleep: about 70 to 90 minutes into the sleep cycle (which occurs 4-5 times). This stage is associated with processing emotions, turning short term memory into long term memory. During thss stage breathing is rapid, irregular and shallow, the heart rate increases, blood pressure rises, the body is paralyzed and overall activity is high.

If you don't sleep enough you don't get enough time in these stages, especially N3 and REM that is the only reason it is important to sleep long enough.

So now enter Xanax (alprazolam), a benzodiazepine approved to treat acute anxiety states, for the management of anxiety disorders, panic disorder with or without agoraphobia, and anxiety associated with depression.

Notice how I do not mention anything about insomnia or sleep? The reason is because, although Xanax is sedating and it can help people fall asleep (ie it can "knock you out") it is unbelievably destructive and potentially damaging to sleep. That is why Xanax is NOT approved for sleep.

If you take Xanax at night for a few days then it is not likely to cause problems, especially if you have not been getting enough sleep. Past that Xanax will drastically reduce the amount of time spent in N3 and it will delay entrance into REM. Over time people may simply stop having any sleep in N3. As a result even 24hrs of uninterrupted sleep would not be as effective as 4-5hrs of normal healthy sleep. Potentially the damage can become irreversible or it may take years to become normal.

Other benzodiazepines like Klonopin, Rivotril (clonazepam), Valium (diazepam), Ativan (lorazepam), Serax (oxazepam), Librium (chlordiazepoxide), and Tranxene (clorazepate) also cause the same effects. Actually every drug I listed is not approved for sleep and should not be used for sleep.

There are drugs that have little or no effect on sleep stages, they are fine to take, and they are highly efective and unlike Xanax and the others are actually approved to treat insomnia.
Only one benzodiazepine, temazepam, is really excellent for sleep and has only minimal effects on sleep architecture. In North America the brand name is Restoril, the typical and generally most effective dose is 30 mg. The drugs Ambien, Stilnox (zolpidem), Ambien CR (zolpidem extended-release) Edluar (zolpidem sublingual) Sonata (zaleplon), Imovane, Rhovane, Zimovane (zopiclone), and Lunesta (eszopiclone) are also approved for sleep, highly effective, and do not cause any significant disruption.
Source(s):
M.D., C.M. psychiatry, internal medicine (Québec)
Hons. BSc in pharmacology

Source: http://au.answers.yahoo.com/question/in ... 001AAjQipQ

With that said, personally, I'm going to try going off the xanax at night and just use it for anxiety throughout the day until my next appointment with my Psychiatrist.

Thank you for this topic and perking my interest. I hope what I added can prove helpful to you and others.

jnk · Post by **jnk** » Thu Jul 26, 2012 8:38 am

lazer wrote:With that said, personally, I'm going to try going off the xanax at night and just use it for anxiety throughout the day until my next appointment with my Psychiatrist.

It is my personal opinion that such decisions are best made in conjunction with, or after, such an appointment.

Here is some recent info which includes some relevant opinions on longterm use of certain meds for sleep, if these links work for you:

http://www.dovepress.com/getfile.php?fileID=12438
http://www.bjmp.org/files/2012-5-1/bjmp ... 1-a501.pdf

lazer · Post by **lazer** » Thu Jul 26, 2012 10:05 am

jnk wrote:
lazer wrote:With that said, personally, I'm going to try going off the xanax at night and just use it for anxiety throughout the day until my next appointment with my Psychiatrist.
It is my personal opinion that such decisions are best made in conjunction with, or after, such an appointment.

Here is some recent info which includes some relevant opinions on longterm use of certain meds for sleep, if these links work for you:

http://www.dovepress.com/getfile.php?fileID=12438
http://www.bjmp.org/files/2012-5-1/bjmp ... 1-a501.pdf

Thanks for the concern. I have actually experimented in the past on my own with the "xanax" and reduction even to the point where I mistakenly went off of it completely for a period of approximately 30 days in which I did develop some chest pain problems and panic attacks so I got back on it. This was late last year. My Psychiatrist is fully aware of this experiment already and why I am back on a .25mg dosage of xanax up to 3x daily for anxiety and a 1mg dosage at night for basically insomnia. I don't see any dangers of trying some "nights" without it as long as I take it during the day for now.

The links did provide some good information. Basically temazepam (40mg) would be equivalent to the 1mg of Xanax for the night-time and more aimed at the Insomnia issue which would make sense for that and as the article I quoted above said it was least disruptive (benzodiazepine) regarding sleep architecture.

I'm also considering seeing what the doc thinks about the Zolpidem in place of the xanax (at night).

The reasons I am considering this change is three-fold:

I would like to ease off the xanax
The two mentioned alternatives per the research I've done are less likely disruptive to sleep architecture.
The two mentioned are also available to me as covered "generics" under my BCBS Insurance plan.

And I hope I didn't derail this thread...

How do you feel about taking Valium with CPAP therapy?

How do you feel about taking Valium with CPAP therapy?

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