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Old 12-03-2009, 06:07 PM   #1
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Pain Meds and Sleep Apnea???

I am taking pain medication (Nucynta 50 mg 4x daily) and just had an overnight sleep study done last night. When I woke up this morning, the resperatory therapist monitoring me told me that I have sleep apnea and that I will need to be fitted for a CPAP machine. I started reading on-line, however, of the fact that pain medications alone can cause sleep apnea problems because they depress respiration. Add to that, the fact that I take 5 mg of Valium a day for muscle spasms. Of course I plan on talking with my doctor (have an appt next week), but I was wondering if anyone else on opioid treatment and/or muscle relaxants is having similar problems with sleep? At this point, I am thinking that the Valium has to go. As far as the Nucynta goes, my PM doctor told me that it was a very weak opioid with only 1/20 of the potency of Morphine but it's effects are potentiated by the addition of another non-opioid component of the medication. My head is spinning. I have taken pain medications for years now. I can't even really recall when I started feeling run over by a truck when I wake up in the morning. Thanks for any comments/insights. Lisa.

 
Old 12-03-2009, 07:50 PM   #2
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Re: Pain Meds and Sleep Apnea???

Quote:
Originally Posted by CaliGirl View Post
Of course I plan on talking with my doctor (have an appt next week), but I was wondering if anyone else on opioid treatment and/or muscle relaxants is having similar problems with sleep?
One has to be very careful when mixing narcotics with any type of muscle relaxers and / or benzodiazepines.....Really any type of depressants period. The synergistic effect is tremendous. Individually, each have minimal risks. However, together, they are very serious. Both used together, or the cocktail effect, can really depress one's system. Some Docs won't use the two in combination for this very reason. Another cocktail example is Tylenol and alcohol. Each individually are incredibly safe. However, when used together, or in overlapping scenarios, they can kill someone.

However, I'm not that familiar with Nucynta....It's a very new med and I don't know the full effects of it. If it's as mild as you indicate, then it may be just fine to use with Valium. In fact, many narcotics are ok to use with other depressants....One just has to be careful and know the full effects. Those with a certain amt of tolerance usually are the safest. As a general rule, the stronger the narcotic, the more potential for overall sedation.

In terms of your sleep, it may be related to your lack of a stable BPL (blood plasma level). BPL is the amt of the med that is in your system. If your BPL dips below a certain point during the night, it can cause one to wake up or at the very least, have restless sleep. Pain meds taken right at bedtime, or even during the middle of the night can often help....Especially if they are long acting (LA).

Patients who rely on BT meds a lot usually have the most problems. This is because during the day, the combination of LA and SA (BT meds) can result in good, high BPLs. However, at night when they are sleeping, they obviously don't take as many meds, or in most cases, no BT meds at all, so their BPL really dips. As stated previously, this can really cause restless sleep.

I am on LA morphine 3 x day and I take one of my three doses precisely at bedtime. It really helps me sleep well and through the night w/o waking.

Hope this information helps and please let me know if you have any questions.

Regards,

Ex

 
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Old 12-08-2009, 10:46 AM   #3
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Re: Pain Meds and Sleep Apnea???

Hi Vali, I've had 2 sleep studies done in the last couple years. Both times the docs dignosed me with opiate induced sleep apnea before I even did the study. I haven't slept more than 3 hours straight insince my last failed back surgery in 99 and when the doc saw my list of meds I think he started picking out what model he wanted to sell me. It pretty much annoyed me that both docs had dx me before even doing the study. It turned out that I didn't have sleep apnea. I have an implanted pump that couln't keep my plasma level any steadier although exec does make a good point. In my case, If I move, turn or roll in my sleep it shifts broken hardware and the pain wakes me. No amount of meds will keep me asleep through that.

If you tested high enough to warrent a trial of an in home unit and there are different degrees of sleepp apnea, If you tested to the point of moderate to extreme or even above level 2, I would say why not give an in home unit CPAP machine a trial.
It could actually save your life if you have severe apnea, The test should have determined how severe the apnea was. If you didn't do an overnight test and just did a quicky day time med induced study I would request a true overnight study be done if your not convinced it's neccesarry.

I don't know how much weight I would give the whole opiate induced sleep apnea theory. The sleep studies determine whether you have it and how severe not hwat caused it. Have you gone back and done another sleep study with CPAP? That's the way they do it around here. If you have apnea and benefit and tolerate CPAP, your insurance will likley let you do a trial at home for 60-90 days. There isn't a medication for sleep apnea it's an entirely different animal than insomnia. CPAP is the treatment unless you are a candidate for the throat surgery.

If you don't have apnea, meds are an option for some but not an answer for everyone.
Good luck, Dave

 
Old 01-28-2010, 08:36 AM   #4
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Re: Pain Meds and Sleep Apnea???

I had sleep apnea BEFORE I had chronic pain. I was also 60 pounds heavier than I am now... but I still need my CPAP machine. I went without it for a while, but the husband started complaining that I was snoring louder and louder and not breathing at some points. So I have started using the CPAP again. (Although I think I need another sleep study, I think the settings have changed since 8 years ago when I first got it).

I am on Opana, nuerontin, and flexeril, with Lunesta to sleep. All of which are respitory suppresants.

If you need the CPAP, use it. You will be amazed at the difference of how you feel. Let alone the risks of heart problems if you have sleep apnea. No matter what is causing it.

Last edited by stertaz; 01-28-2010 at 08:37 AM.

 
Old 02-02-2010, 10:59 AM   #5
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Re: Pain Meds and Sleep Apnea???

Quote:
Originally Posted by Shoreline View Post
I haven't slept more than 3 hours straight insince my last failed back surgery in 99 study. It turned out that I didn't have sleep apnea. I have an implanted pump that couln't keep my plasma level any steadier although exec does make a good point. In my case, If I move, turn or roll in my sleep it shifts broken hardware and the pain wakes me. No amount of meds will keep me asleep through that.
Good luck, Dave
Hello Shoreline, I don't think I've ever talked with you here and would like to ask you something. I hope you will have some answeres for me.

Since the whiplash/car accident neck pain I was "diagnosed" with insomnia. I always need to take sleeping pills. So far it works. But recently stopped working. I'm now on 3 pills a night, my doctor knows that. It's probably tolerance to sleeping pills also.

So you want to tell me since your 99 back surgery you're not able to sleep more than 3 hours straight?. What are you doing when you wake up after 3 hours?. that's not quality of life. Can your doc up your sleeping pills dose?. Will a new surgery getting rid of the hardware will help you get your 8-9 hours sleep?. I know how you feel that's torturing.

 
Old 02-02-2010, 07:07 PM   #6
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Re: Pain Meds and Sleep Apnea???

Hello Fellow CPers,
Happy Groundhog Day!
I had a terrible time with snoring and not getting a good night's sleep. This past spring I had a sleep study done. The results showed non-obstructive sleep apnea. My doctor felt that it was due to the pain meds that I was taking, Fentanyl, Baclofen, Percocet, well you get the idea. Fast forward several months. After having successful joint replacement surgery I no longer take most of the pain medications. Now I don't snore, and the sleep apnea is gone.
I hope this helps.
Peggy

 
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