[CPAP] Introduction

[Knitman]

WEIRD.

Recently I have upped the amount of diazepam due to muscle spasms, well weeks ago. I have started to cut down on the diazepam. Took none during the day(up to 10mg) and reduced the night dose by 2.5mg.

My AHI last night was 9.87 with 82 CAs and 2 HP and 1 OSA.

Previous night it was 1.5.

So I looked up diazepam and SA. Several studies found that diazepam reduced CA !!!

So...it's back to the Dr. 

It had not occurred to me that the reason for my wildly up and down AHI could have been the meds. I knew the morphine affected it but my morphine intake is relatively steady, 180 SR daily with up to 160mg in 20mg quick acting. And as I had such low readings, the morphine wasn't making much of a difference, if any. 

Before I speak to my Dr, I will take my normal(for recently as pain has been worse) diazepam dose today/tonight and see what my AHI is in the morning.

I have always gone up and down with both meds, no troubles except it it seems it may affect the SA but not in the way one expects.

[Sleeprider]

Opioids like morphine are very frequently associated with CA. I have no acquaintance with Diazepam, so I won't pretend my internet search has any relevance. You seem to have enough CA to justify a trial of ASV if your doctor will allow it. Very doubtful given your low LVEF. What I can offer is that CA events tend to be consistently inconsistent, and you have to look at trends rather than individual nights. Your CPAP is not intended to treat CA, but there is a bilevel therapy that has often been allowed for "complex apnea" and may be appropriate where opioid use affects respiration. The ST is not my favorite option, but it can work to reduce these events. ST means "spontaneous-timed" positive air pressure. It provides bilevel therapy in fixed pressure mode with set EPAP and IPAP pressures. As long as you are breathing, it follows your "spontaneous" respiratory inhale and exhale with the pressure changes. When you stop making spontaneous effort, it triggers IPAP on a timed basis, causing pressure to rise during your pause in breathing. This rise in pressure may help queue you to take a breath. The pressure support is usually not high enough to actually cause a breath like ASV, but the nudge of higher pressure is sometimes enough. ST is usually used for COPD, thoracic muscular disorders and hypoventilation to help patients improve tidal volume and off-load some of the respiratory effort onto the machine's pressure support.

I want to clearly say, I am not making a recommendation, but suggesting this is something you could discuss with the doctor other than ASV which seems unlikely. Keep in mind, you have very inconsistent issues with CA, with the last two nights being examples of very good, and borderline acceptable results. Another approach would be to find pain therapy that does not include an opioid. This will obviously need to be supervised and may not be pleasant. You also seem prone to some severe depression as suggested by your post the other night. You might want to discuss whether this depression is related to the medications you are taking. This is something this forum simply cannot help resolve, and I really don't want to see it again.

[Knitman]

Don't worry. You won't. You may recall all you write but not all you read. I a almost m certain  I mentioned I am bi polar.

It had taken a lot of self restraint to not tell you exactly what i think of your last cruel comment but it says so much about you. 




Mj

[Sleeprider]

It was not a comment, it was a warning. We will help all we can with CPAP therapy, but we do draw the limits at mental health.