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Z-drug sedatives to promote sleep during APAP
Z-drug sedatives to promote sleep during APAP
I have had my APAP machine for 7 days and even with brief sessions (< 4h) have had success in suppressing OSA events and more importantly eliminating daytime torpor. But I have yet to fall asleep as best I can tell. 

(1) What are the hallmarks in an Oscar chart of sleep? 
(2) If on-mask sleeplessness persists, can sleep drugs be safely used as adjuncts? 

My own literature searches have found a 2015 Cochrane Review of sedative drug effects on OSA, most of them adverse (see https://tinyurl.com/y3np22e3 ). However they find exceptional the 'Z-drug' sedatives ( zolpidem [Ambien] and eszopiclone [Lunesta] .) They do not aggravate OSA. 

(3) What experience is there in promoting sleep while on APAP with these drugs?
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RE: Z-drug sedatives to promote sleep during APAP
I had talked with my PCP/primary physician on the subject of insomnia but trying to meet compliance with my ASV in 2017. He prescribed Elavil for me at that time. I am not suggesting you ask for that nor that you take that specifically, but that you start by asking the doc what he/she suggests for you. There's other medications, scripted or Over The Counter, that the doc may want you to try. Getting your doc involved also means your medical history is taken into account for taking or not taking anything.

Standard OSCAR Chart Order
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RE: Z-drug sedatives to promote sleep during APAP
I’m not sure it any of these medications would aggravate OSA but I have personally tried Seroquel (very potent dose of 50-100mg only recommended), trazidone (less potent but still strong 100-300mg), vistril (50-300 less potent basically as “cleaner” diphenhydramine (benydryl)) and clonidine (.1-.3mcg note this is for lowering blood pressure so it may interact with meds but this works the best for me) currently in am taking a low dose of all but Seroquel. Just some ideas that are non addictive and can be used longer term. Ask your doc about some of these and do some research. I wouldn’t recommend OCT sleep meds that are antihistamines as they will definitely cause next day sedation.
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RE: Z-drug sedatives to promote sleep during APAP
Thank you both. The Cochrane review I cited covers some of the drugs you mention. Sleep aids like Ambien are popularly regarded as benign .. used for jet lag etc. But they do have an addiction potential when used chronically. I would hope to get away with brief exposure.
I indicated uncertainty in my belief that I didn't sleep while on treatment.
Are intervals with a constant rate of breathing a reliable indicator of sleep?
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RE: Z-drug sedatives to promote sleep during APAP
FWIW - I have been using Zolpidem (Ambien) for over 5 years and been on xPAP for almost 1 year.  I certainly sleep through the night with xPAP, but I can't say that I wake up refreshed, or at least not as refreshed as I had hoped (due to other health issues).  
Dependency could become an issue for anything other than short term use.  But it may be worth a quick try to compare your sleep with/without prescription sleep aids.  Might be worth discussing it with your Dr.

Here is a study saying zolpidem helped with idiopathic central sleep apnea while using xPAP:

Other here on the forum maybe be able to help better with spotting different sleep patterns in your OSCAR charts.  But I generally just go by how I feel in the morning.  If I wake up and feel somewhat rested, I had a good night.
Using a 13" MacBook Air (2017), MacOS Catalina (10.15.7), OSCAR v1.2.0
In a VM: Win10 1909 (18363.1256)

Installing OSCAR on a Mac
Organizing your OSCAR charts
Attaching images and files for the forum
OSCAR Data Interpretation
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RE: Z-drug sedatives to promote sleep during APAP
Thanks for the useful citation, and of course your own personal experience!
I notice that the study is directed to central apnea as opposed to obstructive apnea.
I wonder if that excludes general applicability?
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RE: Z-drug sedatives to promote sleep during APAP
I don't take any sleep aids, but iirc, they can increase events. If you are planning on taking a sleep aid on a temporary basis, watch your results to see if there is a big swing and judge accordingly.

When I first started my treatment I was highly aware of the equipment. Soon it became old news and it was normal.

There is a book "why we sleep" by Matthew Walker, which is a pretty good overview on sleep in general. I think it is there he talks about sleep aids and how they don't actually cause sleep but are more like anesthetic. It's a couple of years since I read his book so I could be wrong about it and my explanation is probably pretty rough. But I feel this is important because the repair work the body does during sleep is inhibited on nights where sleep aids are used.
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RE: Z-drug sedatives to promote sleep during APAP
What you state about sleep aids aggravating apnea events is certainly true with earlier sedatives. That's why I'm specifying the more recent z-class of agents which the studies in that Cochrane review reveal to be an exception to the rule. I'll look up the book you mention to see whether the agents he warns against include the z-class. The latter are popularly used as needed (such as overseas jet travel) rather than chronically and are claimed to have few after effects. Yes, it is encouraging to hear "you'll get used to it", but will that occur during the next few months when I have to prove compliance to Medicare.
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