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Opioid Induced Respiration Depression
#1
Opioid Induced Respiration Depression
I just had recent nasal surgery to correct a deviated septum and reduce turbinate size and during recovery I noticed some interesting changes in my CPAP data. I slowly realized it was due to opioid induced respiration depression which I confirmed by stopping its use a couple days ago. 

I was on a typical dose of Tramacet (1-2 pills every 4 hours as needed) and only taking usually 1 every 6-8 hrs and then 2 before sleep (to dull pain and help sleep). From my research Tramadol (the opioid ingredient in Tramacet) is less prone to respiration depression but without a doubt it was present as can be seen in the following three screenshots.

This first image shows how my respiration rate dropped from an average of 13.5 down to 10.5 on the 5 nights using Tramacet. The lowest my RR has been in nearly 1.5 years of CPAP use was 12 and it rarely drops below 13 so having RR drop consistently to 10-10.5 range seems somewhat significant. You can see that my tidal volume increased a bit higher (500 average is about as high as it ever is and I find it interesting how it kind of flatlined there) to make up for reduced RR and my minute ventilation was slightly lower than usual (5-5.5 vs average around 6).  

   

This second image shows a typical night while on this medication. Note most of the the flagged events are user flag 2 which is a 50% reduction over 6 seconds. For me this index is in the 2-5 range most nights but it averaged just under 20 during these 5 nights on Tramacet. 

   

This third image shows an example of the typical events. You can see how the duration between exhalation and inhalation is extended. In all of the user flag 2 events this means that the Resmed autoset started sending pulse wave to see if current lack of flow was central or obstructive in nature and since you can see return wave form in air flow you can tell that it was central in nature as expected. In this specific example the one instance was very close to being flagged a central apnea (just under 10 seconds long).

   

Anyways I just thought it was neat to notice this and figured I would share for others interest/knowledge of what this can look like on OSCAR. It is something good to know about and keep an eye out for if starting a new medication known to potentially depress respiration (opioids, benzodiazepines, alcohol etc). In my case I only needed the medication short term otherwise I would be asking my doctor for an alternative.
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#2
RE: Opioid Induced Respiration Depression
From personal experience, Tramadol can lower your blood pressure also.  I was taking the generic extended use version of it for a chronic pain situation a few years ago.  I started taking my blood pressure on a regular basis about the same time and found this out.  A friend was also given this after a hip replacement and ended up in the ER with respiration problems.
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#3
RE: Opioid Induced Respiration Depression
I have found myself back on opioid medication (Tylenol T3s to be exact) after fracturing my neck last Friday. My pain hasn't been too bad so I have stuck to 1 pill and usually only take before bed and sometimes one part way through the night if needed.

I was interested to see if there was any central apnea affect this time so looked up data and there has not been. My previous reaction must have been to the higher doses or perhaps Tramadol vs Codeine.

Anyways just something figured worth sharing. If you find yourself in a similar situation it might be worth trying a lower dose or asking to try another medication.
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#4
RE: Opioid Induced Respiration Depression
So what is the back-story of fracturing your neck? Serious business.
Sleeprider
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#5
RE: Opioid Induced Respiration Depression
Work accident. I won't go into great detail but in short I got cartwheeled over a nearly 5 ft handrail, landed on the unprotected side of the platform I was on and then slid off and fell 8-10 ft head first to ground level. I have two stable fractures to my c6 vertebrae, a few gashes to my head and somehow also got a punctured left knee.

It could have been a lot worse so I am thankful it appears I should be mostly healed by Christmas. Just hoping there are no long term issues.
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#6
RE: Opioid Induced Respiration Depression
Sorry to hear about the workplace accident. I was tongue in cheek expecting to hear about some kind of bad judgement or freak accident that should have never happened. I'm more prone to the latter. It's getting rare to see any opioid prescribed for pain relief any more.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Opioid Induced Respiration Depression
Hope your recovery goes well Geer1. I don't recall if opioid pain killers altered my breathing, etc. I do know they weren't nearly strong enough to cut down my severe back pain after breaking 7 different vertebrae over about a year's time. Bad side effect of being on Prednisone too long and setting up osteoporosis.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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