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Trazodone
#1
Hi All,

As some of you know I have not been getting good results although they have improved (see thread for reference http://www.apneaboard.com/forums/Thread-...-weeks-now )

I saw my sleep doctor today and he said whilst the majority of events are CA he doesn't feel the insurance would cover as I don't have enough events. I still feel tired when I wake up and a bit foggy so he has said that as the therapy is "working" he would prescribe Trazodone to help me sleep through.

I dont know anything about this drug but I am very reluctant to take meds, does anyone know about this medication for helping with sleep? or should I be going for a second opinion?

Latest sleepyhead data -

PS I am not allowed to touch the settings as it voids my insurance apparently!!

[Image: SWS0gOg.png]
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#2
When you say you're not allowed to touch your settings, does that include EPR (normally considered a comfort setting)? I could see how adding EPR into your settings would easily put you over the edge for a different therapy.

You probably know Trazodone is an antidepressant and sometimes used in low dose as a sleep aid. It's not a class of medication I would want to use as a band-aid to cover up central apnea. I know very little to nothing about the drug, or its side-effects, but in your case, it is treating something that is not a problem, therefore, its use in this case is off-label. You have neither depression or a sleep problem. You have central apnea. I would not do it.
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#3
I have had personal experience with Trazadone, though it’s been about 25 years (gulp!).

IME I would fall asleep before my head hit the pillow. I was pretty much incapacitated until the next morning. Sometimes, this seemed quite dangerous to me, because I couldn’t drive, be, do, function AT ALL until the drug wore off. Not even in an emergency. Not for the phone. Not for anything. This mattered.

I got an emergency phone call to get to a dying friend in hospital, and I absolutely never should have been at the wheel. I was not properly awake, but luckily the streets were completely empty, so I made it okay. (The friend lived another 3 years, lol).

Do not plan on drinking alcohol at all while on Trazadone.

If you’ve had experience with psychotropic medications (Trazadone is one such), it’s easier to manage how you should be responding, whether you’re prescribed too much, etc.. Otherwise, and if your doc isn’t on the ball, you can have detrimental effects that you might not be clued into as they’re happening. And it’s affecting your BRAIN.

The trazadone I took was prescribed by a PCP.

IMO never accept a psychotropic med prescription from a PCP, even if they tell you they know how to prescribe, select, dose, and monitor them. They don’t: they get alot of their purported prowess from pharmaceutical reps. Your brain is a specialty body part: it needs finesse.

While I’m on this topic, these days there are specialized psychiatric nurse practitioners. They do this stuff all day. They can be fabulous.

I’m not sure I’m making a case against Trazadone; I’m just speaking from experience.

I would lap up support from here and get a second opinion. I’ve been whittling away at a similar situation, and folks have been great. Sleep health is evidently a long process.
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#4
Hi Both,

Many thanks for your informative posts, I have decided before I read your posts that I wasn't going to use the medication for multiple reasons that I am not happy about. I would like to say it has given me comfort in my decision not to take it after reading your posts.

I have also decided that I am going to change my settings and if it voids my insurance I will look to fight it an have a second opinion, I had a rough night with an ahi of 24 last night and feel pretty bad today so enough is enough.

Sleeprider, are you saying I should increase EPR to make the centrals worse so the sleep docs takes notice or reduce further to make the best out of bad therapy?

Best regards,
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#5
(01-09-2018, 02:32 AM)Swisssleeper Wrote: Hi Both,

...
Sleeprider, are you saying I should increase EPR to make the centrals worse so the sleep docs takes notice or reduce further to make the best out of bad therapy?

Best regards,

The question of "should" is tough.  Do I want you to suffer through worse result?  Not really, but if greater than 10 AHI would change your standing for getting an appropriate machine, that is one way of doing so without changing your therapeutic settings.  I think your better strategy is to continue to complain about your sense of health, fatigue, and other problems so that you are granted a bilevel titration test.  That test you would surely fail until you are put on a bilevel with backup rate.  I don't understand nor have experience with how the health system works in Switzerland, so the criteria for obtaining an appropriate treatment for primary central apnea is an unknown.  If you were in the U.S. then your original diagnosis, combined with lack of efficacy on CPAP would be more than sufficient for ASV, even though your AHI is mild with CPAP treatment.  

A completely different approach would be to monitor and record SpO2 to determine if there are oxygen desaturations.  That data could perhaps justify a different therapy approach or supplemental O2.  It could be that you don't have a significant O2 problem but that you instead are experiencing numerous respiratory event related arousals (RERA) that relate to your central apnea.  You may be arousing for these events ahead of desaturation, and this is what is causing your fatigue.

Finally, the root problem comes down to an opinion of your doctor that your event rate may be too low to be provided an alternative therapy, in spite of a diagnosis of central apnea.  If he was supportive, he would make the recommendation anyway, and let the insurance reviewers work it out.  I think you have the wrong guy!  He runs from potential conflict and an aggressive debate of your condition and needs, and prefers instead to give you drugs.  You need a different doctor that advocates for his patients.  So from that perspective, making your conditions worse by adding EPR does not solve the problem that your doctor is a wimp.

Your most logical course of action, to make the best of what you have, is to eliminate as much central apnea as possible, and that would likely occur by fixing your pressure somewhere in the 8.0 to 9.5 range with little or no variation and no EPR. I would look for that to reduce your AHI to the 3-4 range.
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#6
Maybe my .02 cents might help.  I’m a long time insomniac and my quality of sleep is much better after 3 months on CPAP.   My general practitioner doctor prescribed low dose of Ambian and Trazodone.  He said they act of different levels and it was fine to take both. I only take the Ambian (10 mg) occasionaly now.  I have been taking Trazodone nightly at 50 mg dose with no side issues.  I tried 75 mg a couple of nights but it caused blurred vision the following day.  The 50 mg doseage is working fine for me and my doctor said to use it nightly at that low dose.  

What the doctor said is Trazodone at the 50 mg doseage will help to quiet my mind which is my primary problem falling asleep. Seems to work well and no side effects at that dosage for me.

Hope this helps a bit.
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#7
Hi Sleeprider,

Once again many thanks for your detailed post which is very helpful. I agree that I don't think my doctor is correct, from my understanding he is a pulmonologist that also deals with sleep problems and this may be where the issue starts. I have made an appointment to see my GP and hope to get a second opinion. We have an excellent sleep clinic in the CHUV hospital that I think will provide better service. I just need to convince the doctor that I have made enough research and have enough back up that she thinks its a good idea.

My AHI was 14.8 last night and it seems to go in cycles, when I am really tired I have a bad AHI but I feel like I have slept through ,I wake with a bad head and feel foggy in the morning. When I am not so tired I wake a lot an have a better AHI and again feel foggy because I have been awake but my AHI seems better, this is because I leave the mask on even when I am awake.

I have never suffered with insomnia and dont feel the medication is right for me, that being said I appreciate your post CZOscar as I can see that it can help insomnia sufferers. One of the reasons the doc gave it to me was because I said I have awake periods sometimes and he thought the drug was the solution.

Lets see what my GP says and I will update you.

Best,
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