Methadone causing Sleep Apnea?

[Roughrider]

Hey all, thanks for taking the time to review my post. I am a 38m and have had RLS since my early 20s. I have been through the gamut of medications and the opiate class has been the most helpful, with methadone providing 90% symptom relief. While I’m thankful for this, two problems have emerged: extreme daytime fatigue and sleep apnea. I was curious if others had experienced the emergence of sleep apnea with methadone usage and if so, how they addressed it? I’m considering switching to Buprenorphine, however, I do struggle with this given my RLS symptom relief.

[Polar Bear]

I am a 74F and an rls sufferer of 40 years. My treatment is not methadone but is max doses of cocodamol and pregabalin. I also reckon I have about 90% relief.
I have sleep apnea diagnosed 4 years ago. The cpap machine is wonderful. I don't know if the cocodamol plays any part in the sleep apneas but it provides such good rls relief that I'm happy to continue with it.

[Rustsmith]

All opioids are Central Nervous System depressants that can cause mild sleep apnea to become a problem. Gabapentin and Lyrica are also CNS depressants, so they can cause issues too. Every time that I have an appointment with my neurologist, she asks "Are you still using your CPAP machine?". I tell her that I use it every night.

In my case, I was diagnosed with a mild form of sleep apnea (UARS) at the same time that I was diagnosed with RLS, so that was before I had to start on opioids post augmentation. I have had several sleep studies since switching to opioids and my sleep apnea is no worse now than it was when I started. And like Polar Bear, I use a CPAP machine even though it isn't normally used as a form of treatment for my form of apnea.

[Roughrider]

Thank you for both of your replies. I’m aware that methadone can cause sleep apnea, I was curious if others had noticed this as well and what adjustments they made, if any. I had a sleep study done two years prior to going on methadone with no signs of sleep apnea. Now, with the methadone, I wake up with my throat sealed off attempting to breathe.

[Rustsmith]

My suggestion is that you need to speak with your prescribing doctor ASAP. To me, your description of waking with your throat sealed up sounds more like an allergic reaction than apnea. With normal apnea and UARS, you essentially swallow your tongue. With normal sleep apnea, the nerves in your throat do not detect the presence of your tongue and you suddenly awaken gasping for air. With the UARS type of apnea that I have, the nerves detect the tongue and momentarily awaken you so that your tongue returns to its proper position. When I was tested, I was experiencing these micro-awakenings 12 times/hour, which makes it impossible to get beyond Stage 1 sleep.

As for opioids causing apnea, they cause a Central apneas, which occur because the opioid suppresses the body's normal signal to breathe. Central apnea cannot be treated with a normal CPAP machine. It requires at least a BiPAP level machine, which is more like a medical respirator that forces you to breath if you don't do so on your own. Central apnea is also worse at high elevations such as the 6000 ft where I live.

[Roughrider]

Thanks for the reply Rustsmith, it’s very much appreciated. I am in communication with my physician about the episodes and am in the process of getting used to the CPAP. I would like to minimize anything contributing to the sleep apnea. I can relate to the central apneas as I have found myself forgetting to breathe more often. I also find myself doing this with the CPAP and have come across the bipap machine that you mention. At this point, I’m debating between switching to buprenorphine or looking into an augmentation strategy with clonazepam.

[Polar Bear]

My sleep test showed that I had a level of 20 apneas and now that I use the cpap it averages 0.5.
I can recall the waking up gasping for air and feeling for what seemed a long time that I couldn't get a breath. It was very alarming.
You need to have it checked out.

[Roughrider]

Thanks Polar Bear, it is a terrible feeling and even after one catches his/her breath, the feeling of panic doesn’t always subside, making it difficult to get back to sleep.

I have had the issue checked out, which is why I am on the CPAP - I’m simply interested in what others have done who were taking methadone. It’s unfortunate, as methadone has been the only script that works well for me, but the sleep apnea at this point is worse than the RLS.

[Polar Bear]

I meant that you should have it checked out as to why your sleep apnea is so bad even though you are using the cpap. If it was me I'd be thinking something needs adjusted/changed so I'd know if I could comfortably continue with the methadone, or not.
Only my own thoughts. I have no medical training and I do not use methadone.

[Roughrider]

Understand Polar, and I apologize, I should have been more clear - I have only noticed my throat sealing off when not using the CPAP. Otherwise, the main issue I have is being awoken by the CPAP machine and then feeling panicked, but I’m finding ways to get past this. I believe next steps for me are to look into switching to buprenorphine, thanks everyone for your comments and support.

[debbluebird]

If I don't sleep on my side, my apneas are worse. On my back they will be in the 30's. On my side 5. Those numbers are with my machine. I went from cpap to bipap. Now I have an ASV Machine. I have severe obstructive sleep apnea and severe central sleep apnea.

[Roughrider]

If I don't sleep on my side, my apneas are worse. On my back they will be in the 30's. On my side 5. Those numbers are with my machine. I went from cpap to bipap. Now I have an ASV Machine. I have severe obstructive sleep apnea and severe central sleep apnea.

I have noticed this as well and tend to start on my back and rotate to my side. Sorry to hear how severe your sleep apnea has become, when did it begin for you?

[Rustsmith]

When I had my first sleep study, I was able to get the detailed results of the study. One of the parameters that they reported was the percentage of time on my back, sides and stomach as well as my AHI number for each position. I was surprised to see how much time that I spent on my back because I had always thought of myself as a side sleeper. I don't remember seeing that breakdown in later study results (I have had four of them), but the results from the last three studies weren't very useful because I didn't sleep very much due to RLS-insomnia issues.

[debbluebird]

If I don't sleep on my side, my apneas are worse. On my back they will be in the 30's. On my side 5. Those numbers are with my machine. I went from cpap to bipap. Now I have an ASV Machine. I have severe obstructive sleep apnea and severe central sleep apnea.

I have noticed this as well and tend to start on my back and rotate to my side. Sorry to hear how severe your sleep apnea has become, when did it begin for you?

I had my first sleep study in 2009 and got my first machine.

[RestlessNan]

medications and the opiate class has been the most helpful, with methadone providing 90% symptom relief. While I’m thankful for this, two problems have emerged: extreme daytime fatigue and sleep apnea. I was curious if others had experienced the emergence of sleep apnea with methadone usage and

Thank you for both of your replies. I’m aware that methadone can cause sleep apnea, I was curious if others had noticed this as well and what adjustments they made, if any. I had a sleep study done two years prior to going on methadone with no signs of sleep apnea. Now, with the methadone, I wake up with my throat sealed off attempting to breathe.

If I don't sleep on my side, my apneas are worse. On my back they will be in the 30's. On my side 5. Those numbers are with my machine. I went from cpap to bipap. Now I have an ASV Machine. I have severe obstructive sleep apnea and severe central sleep apnea.

Are all of you getting plenty of moisture with your setups and in your bedrooms?
I have noticed this as well and tend to start on my back and rotate to my side. Sorry to hear how severe your sleep apnea has become, when did it begin for you?