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[Diagnosis] Could Sleeping Pill During Test Cause False Apnea Diagnosis
#1
Hi, I am new to the Board, and this is my first post. I have a strange dilemma.

I've had severe insomnia for many years, and have taken Ambien for it for years, which works well. I was suffering from exhaustion and muscle pain, and had a very high red blood cell count, which my doc felt could be oxygen deprivation from sleep apnea, so I had overnight testing done. Despite taking 10mg of Ambien, I had a terrible time getting to and staying asleep during the test, but they were able to get about 4 hours of data.

Long story longer, the test did show lots of hypoapneas, virtually no REM and virtually no deep sleep. Here's the dilemma. My ENT feels that maybe the reason I have apnea is because I am taking the Ambien, and that, by giving it up, maybe I won't need CPAP. Of course, I tried re-taking the test again w/out Ambien, barely slept, but in the two hours I did sleep, had no apnea. So now my possible choice is give up the meds, or be on CPAP, which I am having a terrible time adjusting to.

I know it sounds like a no-brainer: Meditate, go drug-free, and live a blissful life of no CPAP, but not if you've suffered tossing and turning since age 5, and the meds knock me out in 15 minutes.

Has anyone ever heard of sleep meds actually causing apnea? I can't completely test the theory, because I don't really sleep well w/out meds. Cognitive therapy, sleep hygiene and all that other stuff doesn't work for me.

It's kind of a Catch-22 situation. Thanks so much for reading all this. I'd love it if anyone had any insight. Thanks
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#2
Welcome! Well, you have a whole lot of everything going on.

As a (previously) long term insomniac and frequent broken record, I will suggest that you look into sleep compression therapy. It sucks, horribly, but it worked for me. Quoting my sleep doctor, "pills are a dodge, you need to treat the cause".

I've not heard of drugs causing apnea but they can certain make it worse (alcohol for example).

Having a terrible time getting to sleep in a sleep study is pretty much expected. I went into my last one used to CPAP, dead tired, and lay in the nest of wires for five hours before getting to sleep.

The real question you need to ask yourself is, "Am I willing to commit to life on CPAP, or do I want to fight it"? The former we can help, the latter...

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#3
Thanks so much for responding. Is sleep compression where you go to bed later each night until you've gone around 24 hrs, cause I've tried that. So far I'm going with the CPAP and I'll post my tale of woe soon.

In short, I've tried pillows and a mask, and as soon as I have an event and the pressure goes up I start mouth breathing and wake up so I've ordered a full face and we'll see. After 30 days of trying, I've only managed a maximum of 3 hours w/ the mask, with lots of leaks, so I look forward to lots of sage advice here.
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#4
G'day Violetskyye, welcome to Apnea Board.

Whether or not you have apnea is almost a moot point - based on my own experience, I can say that CPAP treatment can pretty much eliminate insomnia. Like you I was a long term insomniac and dependent on zolpidem (ambien, stilnox) to sleep. And two nights out of three it didn't work and I would be awake until 3 or 4 am. After going on the hose I've dropped my zolpidem dose by half and I'm asleep within minutes, every night. For that alone the machine is worth it for me. I could probably cut the zolpidem out entirely but I think there is a psychological dependency at work, which I'm prepared to live with.

I've discussed sleep issues with my GP, who believes that zolpidem is unlikely to be a contributing factor to my apnea. It's not a CNS depressant like alcohol or valium. In my case I have complex apnea, with about 50% of my events being obstructive and 50% being central apnea. In your case, it might be worth getting off the drug somehow then reviewing your apnea status, but my suspicion is that it won't make a huge difference. Alternatively, embrace the hose and then wean yourself off (or at least cut the dosage).

As regards leaks and mouth breathing - this is the hardest part of the therapy. You need to try as many masks as you can to find one which suits you and doesn't leak. Be prepared to work on your DME to have them co-operate in this quest. Mouth breathing can sometimes be fixed by using a chin strap, and a lot of people have mastered the tongue-stick method. Personally I much prefer a full face mask so it has become a non-issue.

Hope this helps
Paul
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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#5
Hi Violetskyye,

I had what I would characterize as fairly bad insomnia. I really would not care to experience worse though I am sure that many have. I would spend long periods in bed, much of it awake, never sleeping for long periods. By the time I went to see a doctor I literally could not put a sentence together. The entire exam was a series of 3-4 words followed by a 30 second or so pause while I tried to come up with the next few words. The doctor put me on sleep meds and sent me to a sleep doc.

Sleep Compression (or Sleep Restriction) is where are you are assigned a fixed time in bed after which you must get up. MUST get up. Sleep or no sleep. And it is not a long time. You might call it sleep deprivation therapy. Or treating insomnia with extreme violence. It is unpleasant, consider yourself warned. Smile It sounded nuts to me, it still does, but it worked shockingly well to reset a lifetime habit of insomnia.

My time was based on my PSG and set at 5.5 hours (from memory). I'd been on sleep meds for weeks (months?) when I did this. I went off them for this. The first day I got up, I probably had 1-2 hours of sleep. I was a wreck. This continued for a few days. Then I started sleeping. And sleeping. For almost the entire 5.5 hours. My interpretation of this is that your mind (e.g. the thinking part of you) is what keeps you awake and your brain (e.g. low level body function) needs to sleep. Desperately. Eventually it overrules your mind and when you lie down, you sleep. After a couple of weeks, you can extend your time in bed to allow for a fully restful sleep.

https://www.painscience.com/articles/insomnia.php
http://www.peterfrenchhypnotherapy.co.uk...mpression/
http://www.sleepdex.org/restriction.htm

I think that part of your CPAP problem is your 4-11 settings. Firs,t 4 is pretty low in terms of airflow to breathe. I'd feel suffocated. More importantly, the Resmed machines move FAST when events happen and 4 to 11 is a BIG jump in pressure. I am pretty sure that I would open my mouth and wake up too. A full-face mask might help here. But I think a minimum pressure closer to your median or 90/95% pressure would too. You will probably need to get there gradually to get used to the pressure, specifically exhaling against that. The EPR setting on these machines can help. I will also advice trying to not use the ramp or set it to something like five minutes. It is just one more thing that is changing while you are trying to get to sleep.

So, what pressure range to use? Do you have a copy of your sleep studies? Did the first study include a pressure titration? Which AirSense machine do you have? See the pictures here http://apneaboard.com/cpap-machine-pictu...ine-resmed
If you have the Elite or AutoSet, you can use the SleepyHead software (link at top of this page) to get a detailed view of what is happening. It can also help to identify a smaller range of pressure which will be more effective (e.g. I was titrated at 14 and use a pressure range of 13-16).

Hope some of this is helpful to you.
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#6
My titration showed that if I use continuous setting it should be 7. Hmmm, maybe I'll try starting at 6. Yes, the Sleepyhead will show it stays at 4 for a while, then jumps to about 8, and then 10-11 at times. I'll try to post an image, but the readings are never pretty, and AHI is rarely below 9.

I think if I wore it longer the AHI would go down, because I'll have a series odd events, then wake up, then keep the mask on and fight to nose breathe for a half hour and then just pull it off, so concentrated in 2 1/2 hours, it's a lot of events per hour. I've even re-started the machine to go back to ramp, but once I'm awake, I'm awake.

My full face mask arrives Monday, and I'm hoping that helps solve it.

I may try compression. I'm working at home and can sleep in, and I think that makes my sleep undisciplined. I should get up at a set time, which is hard, though most of my life, I've had to get up very early every day and still had sleep problems.

Thanks for your encouragement.
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#7
Keep in mind that your titrated pressure in the sleep lab is just a point in time. And neither night reflected very normal sleep. But it is a starting point. What is your median and 90 (or 95)% pressure in SleepyHead? 6 or 7 sounds like a good place to start and you may find it need/want to move it up from there.

It is very normal to have a higher AHI to start with and for it to fall as you get used to the therapy. That is certainly what happened to me, along with a little encouragement from increasing the pressure over time. An AHI of 9 is still way, way too high for the therapy to have a good effect.

I also work from home and "suffer" from lack of discipline in getting out of bed at a consistent time. It is just so darn warm and comfortable. But even with that, my insomnia has not returned. Sure, I do get the occasional night when something keeps me awake but it was every night, all year long before.
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#8
Hi Violetskyye,
WELCOME! to the forum.!
I want to encourage you to stick with CPAP therapy and good luck finding a mask that works well for you.
Hang in there for more responses to your post and much success to you on your CPAP journey.
trish6hundred
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#9
Median pressure is 4.34, 95% is 9.12. That's from a night with only 3 hours of use, which is as much as I can get so far.
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#10
Have you tried a higher starting pressure? It might actually relax you. Based on your titration study, and minimal data results, a start of 6.0 is probably where you need to be. It's not that much, and makes breathing easier. You won't really notice when pressure increases, and if you're using EPR, you will actually get some pressure difference between inhale and exhale. The machine does not go less than 4.0 cm pressure, so if that is your starting pressure, there is no EPR.
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