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Clonazepam/OSA and APAP
#1
Clonazepam/OSA and APAP
Hi so I’m unfortunate to have not only OSA and treated with APAP Resmed 10 Auto but I also have RBD (REM Sleep Behaviour Disorder) with early onset Parkinson’s disorder and bipolar disorder. So....

I am using my APAP and noticed my AHI has been below 1.0 (apart from last night for whatever reason it was 1.2 but it’s still very low). I have also been prescribed Clonazepam at night up to 2mg for my REM Sleep Behaviour Disorder. I am wondering how much Clonazepam can effect OSA, if I should be using as much as that with CPAP and whether that is what’s causing the pressures to go higher.

I also take duloxetine and lamotrigine at night. Lamotrigine morning and night.
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#2
RE: Clonazepam/OSA and APAP
You ask if that much clonazepam might affect how you sleep with PAP. I’d look at it like this: would you dare not to use PAP knowing the drug improves your sleep state changes, and that it deepens your relaxation? 

It doesn’t sound like a big dose, and it is presumedly doing its job. I would look to my morning reports, and to whether I feel rested, and not second guess the interaction if both are good.
Serial Tapist
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#3
RE: Clonazepam/OSA and APAP
2mg is pretty strong for a healthy person. I can't comment on your particular situation though. If it doesn't turn you into a drooling 2 year old and only calms you down, then I'd say it's not too much.
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#4
RE: Clonazepam/OSA and APAP
I feel obligated to qualify my first response. The typical prescription is for between 0.1 and 0.3 mg/kg of body weight. However, I don’t know what you weigh, for one thing, and that dose is often meant to be split into two or even three portions over 24 hrs. So, please reread your prescription directions carefully. If it is to be taken only at night, that’s how you should do it.
Serial Tapist
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#5
RE: Clonazepam/OSA and APAP
(07-04-2020, 04:05 PM)Davidacarrick Wrote: Hi so I’m unfortunate to have not only OSA and treated with APAP Resmed 10 Auto but I also have RBD (REM Sleep Behaviour Disorder) with early onset Parkinson’s disorder and bipolar disorder. So....

I am using my APAP and noticed my AHI has been below 1.0 (apart from last night for whatever reason it was 1.2 but it’s still very low). I have also been prescribed Clonazepam at night up to 2mg for my REM Sleep Behaviour Disorder. I am wondering how much Clonazepam can effect OSA, if I should be using as much as that with CPAP and whether that is what’s causing the pressures to go higher.

I also take duloxetine and lamotrigine at night. Lamotrigine morning and night.

It appears that nobody may give you a more accurate answer than your sleep doctor as it appears that it is dependent on your physical condition, drug interactions, and dosing schedule. You may wish to regard all proffered advice as anecdotal and stick with your prescribed regimen.

Best of luck for a good night's sleep and a better tomorrow.


1027 Effect of Clonazepam on Obstructive Sleep Apnea Coexisting with REM Behavior Disorder: A Case Report.
Quote:Introduction
Rapid eye movement behavior disorder (RBD) is a parasomnia characterized by loss of muscle atonia during REM sleep, resulting in excess motor activity and dream enactment. These behaviors may lead to interrupted sleep and injury to the person or their bed partner. Obstructive sleep apnea can coexist with RBD and the treatment of one may affect the course of other condition. We report a case of RBD and the effect of Clonazepam treatment on the severity of concomitant OSA.

Report of case
Sixty six year old female without any significant past medical problems presented with abnormal behavior during sleep including screaming and attempt to ambulate, sometimes resulting in injury. She also had snoring and daytime fatigue. She did not have symptoms of cataplexy and she was not on SSRI. Detailed evaluation was negative for underlying neurological/psychiatric disorder. Her Epworth sleep scale (ESS) score was 2. Overnight polysomnography was significant for RBD and OSA (AHI 5.5/hour). She was initiated on Clonazepam & Melatonin for RBD and CPAP for OSA. Over next few years, she reported improvement in behavioral symptoms during sleep, but developed worsening of daytime sleepiness (ESS score 7). Repeat polysomnography showed AHI of 16/hour. There was significant improvement in observed REM behavioral abnormalities compared to previous study. Regarding OSA, she developed CPAP intolerance, eventually requiring BiPAP as indicated by titration study with subsequent improvement in symptoms.

Conclusion
There is paucity of data on the complex interplay between RBD and OSA. Clonazepam is commonly used to treat RBD, but the mechanism of action is unclear. Clonazepam may possibly be associated with worsening of OSA, as observed in our patient and few previously reported cases. Knowledge on the underlying cause of this effect is limited. Our patient was also on Melatonin, but previous reports showed Melatonin might be associated with improvement in OSA. Our case shows the need for watching for onset or worsening of OSA symptoms in patients with RBD on Clonazepam. This observation also indicates the necessity of further research in this field.
Obstructive sleep apnea syndrome induced by clonazepam in a narcoleptic patient with REM‐sleep‐behavior disorder

Quote:Although the available data on the effects of benzodiazepines, and of clonazepam in particular, are conflicting (Bonnet et al . 1989; Guilleminault et al . 1988; Hanly and Powles 1993; Kimura et al . 1998; Mendelson et al . 1981), the present data provide convincing evidence that clonazepam can induce disturbances of nocturnal breathing. A causal relationship is suggested by the finding that the AHI rose sharply when clonazepam treatment was started and promptly decreased when clonazepam treatment was stopped. Because our patient was overweight and snored before the treatment, it is possible that detrimental effects of clonazepam on nocturnal breathing occur in predisposed individuals only. We conclude from the present case that patients treated with clonazepam should be carefully monitored for the possible development of OSAS.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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