Very confused about apnea

[vsheline]

Hi msmcintosh,

Here is an announcement of a recent study. Perhaps you can ask your doctors to look up the study, which looks at combining supplemental oxygen therapy and BiPAP therapy in treating Sleep Apnea in veterans prescribed opioids, with 92% success rate. (Perhaps combining supplemental oxygen therapy with ASV PAP therapy would have been successful with the remaining 8%, but that was not tried.)


Methods for Treating Sleep Apnea in Veterans Prescribed Opioids

Categorized in: Department of Defense (DoD), Department of Veterans Affairs (VA), January 2013

DETROIT--Using a titration protocol with continuous positive airway pressure (CPAP) and then positive (PAP) with oxygen effectively eliminates central sleep apnea (CSA) in veterans with underlying comorbid conditions and prescription opioid use, according to a new study from the John D. Dingell Veterans Affairs Medicine Center in Detroit.1

Noting that (PAP) titration protocols for CSA are poorly defined, the authors used retrospective chart review to determine the impact of a stepwise titration protocol using PAP therapy and supplemental oxygen in a sleep clinic population of patients with multiple comorbid conditions and particularly with prescription opioid drug use.

They point out that CPAP eliminates central apneas in 50% of CSA cases, while CPAP in combination with oxygen is effective in an additional 25%.

“There are no standard therapies for the management of central sleep apnea (CSA),” the authors explained in the Journal of Clinical Sleep Medicine article. “Either positive pressure therapy (PAP) or supplemental oxygen (O(2)) may stabilize respiration in CSA by reducing ventilatory chemoresponsiveness. Additionally, increasing opioid use and the presence of comorbid conditions in U.S. veterans necessitates investigations into alternative titration protocols to treat CSA.”

With 162 patients diagnosed with CSA, the protocol was effective in eliminating CSA in 84% of patients. CPAP was effective in 48%, while CPAP plus oxygen was effective in an additional 25%. BPAP with oxygen was effective in 11%, but the remaining 16% were nonresponders.

Of the patients with CSA, 47 (29%) were on prescribed opioid therapy for chronic pain. For them, CPAP, CPAP+O(2), or BPAP+O(2) eliminated CSA in 54%, 28%, and 10% cases, respectively.

1.Chowdhuri S, Ghabsha A, Sinha P, Kadri M, Narula S, Badr MS. Treatment of Central Sleep Apnea in US Veterans. J Clin Sleep Med. 2012 Oct 15;8(5):555-63. doi: 10.5664/jcsm.2156. PubMed PMID: 23066368; PubMed Central PMCID: PMC3459202.

http://www.usmedicine.com/articles/metho...R31XWcrHJR

[msmcintosh]

Hi vsheline,

Thanks for the information. I don't really understand a lot of it. In the real world it would probably be helpful and I wish with all my heart that someone at the VA hospital would be interested. But unfortunately, I believe my pain management doctor believes the only way to keep me alive is to is to keep me from taking opioids. The head doctor from the sleep clinic wrote to him and said my sleep apnea was likely caused by my opioids and recommended eliminating them. Since then, every time I've communicated with my pain management doctor, I really think he is afraid I am going to die in my sleep if I take them. He's told me if I take anything, never at night. He told me he would have prescribed opioids if it weren't for the sleep study.

If I ever get to see someone that might appreciate the information you provided, I will certainly share it with them.

I'm really hurting, so I'm not sure what's going to happen.

[Shastzi]

Hmm. Ok. I think I see.
I would have liked to see a larger sample and a group on opioids getting straight BIPAP (no O2) but I guess that's for later.

Thanks vsheline!
Looks like for now, straight CPAP is keeping you alive till further notice?
:/

[msmcintosh]

I was in a lot of pain yesterday, so I decided to try an experiment. Before going to bed, I took a 50mg Kadian (12 hour time release Morphine) and 10mg Oxycodone. I don't plan on continuing using these meds, although they help.

If any one is knowledgeable enough to interpret the attached report, I'd really appreciate it. The graph of my pulse looks unusual.

I don't know if one night of opioids is enough for a test. The Adjusted Index looks close, but the %SpO2 looks to be somewhat lower. My results look nothing like those of the VA sleep study, which makes me wonder why? I had run out of my benzodiazepine a week before the study, so it wasn't included in the VA study. The VA AHI is so high compared to my reports. I don't understand.

I think the 02-10-2013-no-opioids.pdf report looks pretty good. I think if I get similar results with their take home study, they will blame the opioids.

I have no clue what my appointment at the sleep clinic is for. It's at 11:00 AM. It could be for a clerk to give me the take home kit. Maybe some one I can show the reports to.

I spoke to my PM doctor and he has given me hydrocodone to take during the day. We'll see how that goes.

[archangle]

Zoom in on some of the downward blips. Make them big enough that the blip fills about half the screen with a little normal O2 level on both sides. You need to look at how long they last, how low the O2 goes, and if they look real vs. looking like a glitch or moving the sensor around.

I don't see anything immediately life threatening in the graphs you posted. A few blips down a night aren't a problem, unless they're long in duration and/or get down to a really low O2 level.

However, I'm not a doctor. Maybe there's some risk that you'll just suddenly jump from a few minor low O2 incidents to just not breathing at all. Or maybe the effect will build over several days of use.

Maybe your doctor will be OK with monitoring the O2 and seeing if anything develops over time after using your meds for several nights.

By the way, O2 levels aren't the whole story. You may partially wake and start breathing before your O2 drops enough to register. The sleep disturbance and hormones can still be harmful long term.

[msmcintosh]

I think this might be the take home sleep study kit the VA uses: Nox-T3 Portable Sleep Monitor. On the Nox Medical web site, it explains what it monitors, etc., which explains a lot.