If your sedative (Methadone) causes central apnea

[doety]

I hate to post something this long, but I'm struggling with this and perhaps somebody else might be. I've been researching central apnea and found this, which makes sense:

Disrupted breathing during sleep creates a number of undesirable symptoms. Those who suffer from CSA are chronically fatigued, have headaches, and have restless sleep. Other symptoms may include weakness or numbness and difficulty swallowing.

There are a number of ways to diagnose this sleep disorder. Sleep studies confirm CSA, as well as physical exams. For more serious cases of Central Sleep Apnea, an MRI to check the brainstem may be necessary.

A common misconception for treating this sleep disorder is to take a sleep supplement or sleep aid. Unfortunately, any use of sedatives leads to a risk of collapsing the airway during the night.

Those who have moderate cases of Central Sleep Apnea will need a different mechanism to get Oxygen to the brain. A nasal CPAP is a plastic facial mask that opens the airway helping facilitate breathing. A nasal CPAP is a mechanism to help individuals breath and is not a cure for CSA.

Severe cases of Central Sleep Apnea may require surgery. Surgery is an actual cure for sleep apnea, and will open the airway space permanently. After getting surgery, people should have improved sleep quality and duration.

[ViewsAskew]

Doety, seems to me that if methadone can cause this, then any opioid could. They all reduce bodily functions such as respiration rate and heartrate. (At least I think so....)

Have you seen anything about that in any of the studies you've read?

[doety]

Not really. I'm still looking. This is so scary. I wake up in the morning exhausted, sometimes get up, lay on the couch and sleep some more. Sometimes it seems like the CPAP interferes with my breathing.
I'm afraid one morning I won't wake up.
My father died at 57 of a massive heart attack, but he had horrible sleep apnea, back when nobody was concerned about that.
I'll continue my experiment tonight, cut back to 10 mg. of Methadone, add a little more Mirapex and see how I do.
I'll also e-mail the doc who diagnosed it, on Monday.

I'm wondering.....you know I've discussed having horrible RLS when I wake up? I'm never sure what's RLS and what's apnea. Perhaps depriving my brain of oxygen could kick off the RLS in the morning???

[sleepdancer]

Doety, when taking in a lot of unfamiliar information, it is good to do as you are doing and bounce it off others to help sort through some things. I don't know if I can address a lot of it, but some things stood out to me.

Surgery to open the airways is to address obstructive sleep apnea, not central sleep apnea. When one has episodes of central apnea, the airway is open. The way our lungs know when to breathe is the brain monitors the rise and fall of the balance of oxygen and carbon dioxide in the body and signals the diaphragm and respiratory system to methodically regulate that balance by breathing. If that part of the brain is compromised or suppressed, it can misread the levels and fail to recognize the need to send signals to breathe. With CSA the airway can be wide open, but still not move air. Many people have occasional central apneas that are of no concern, but to have significant numbers with prolonged duration, oxygen desaturation, and causing awakenings is cause for seeking resolution.

If one is prone to CSA due to medical reasons or medication effect, using a standard CPAP may not be the simple solution. A standard CPAP will address the OSA, but if high pressures are needed to avoid obstructions, those high pressures can confuse an already compromised brain and in some even contribute to centrals. Those with both OSA and CSA sometimes need a bi-pap, or even a special bi-pap that will both keep the airways open AND breathe for the patient if their brain doesn't get it right. Those machines have a feature similar to a ventilator.

Then if you add RLS and/or PLMD to this situation, it can be very hard to know which is continuing to cause trouble sleeping. I do hope you are under the care of astute doctors skilled in handling cases such as yours. I cannot presume to know better than you or your doctors what's best for you. I can only say that I would have to have exhausted every other possible solution before taking a med that caused me to have centrals. The machines needed to manage it are complex and expensive, and treatment should be regularly monitored for effectiveness. You mentioned adding a medication for the central apnea? I just get weary of adding meds to correct what another med has caused. Where does it end?

If you were able to eliminate the central apnea aspect of your equation, it still can be difficult managing the combination of OSA and RLS/PLMD. I've logged extensively about my struggles through the years on cpaptalk and it has not been an easy journey. Believe me, I am not saying your RLS symptoms don't merit the type of med you are on. Just saying, be very sure you aren't trading troubles, or at least be sure the tradeoff is worth it.

Keep reading and educating yourself. OSA, CSA, RLS/PLMD can all be managed simultaneously if that it what is required. Just gotta know your doctors are top-of-the-line.

[doety]

Ann:
Thanks for taking the time to do all that. You're the first person I know who's ever heard of CA. And you're right, I need an objective person to look at all this.

Just re-reading what I copied from some research in my reply above -- you'll see that they recommend surgery. And you're saying that wouldn't address the problem because that surgery is really for sleep apnea. More than anything, you're saying get a good doc.

Obviously, I don't have one. Porter Hospital is advertising a sleep clinic; I'll call there and see if someone will talk to me. I keep bouncing around at Kaiser and although I like them, I'm not sure they can handle this. A Kaiser doc put me on Methadone to begin with.

Right now, the depressants I take are 1/2 a .5 Klonopine and since last week, 15 mg. of Methadone. I noticed a distinct difference when I went from 20 to 15 mg. of Methadone. I wasn't as sleepy during the day. Tonight I'll try going down to 10. I had added 1/4 of those tiny Mirapex pills and I think tonight I'll increase that to 1/2 tablet. I don't want to take so much that I go back to augmenting.

I've been trying to research CA on the net, but already I'm seeing people contradict themselves. One said to use supplemental oxygen, another said it wouldn't do any good -- because, as you said, it's a brain communication problem.

Of course, before all this, I had plain old sleep apnea, or that's what they thought.

I just remembered last night I drank about 4 sips of wine. I never drink. I know I'm not supposed to when I take Methadone. But that may have been just enough to depress my breathing more and make today horrible.

I'll see my therapist on Monday -- she's also acting like a reality check for me. Because of all this I know I'm not thinking straight and I can't rely on myself totally. One article talked about getting an MRI to look at the brain stem (not even sure that makes sense). But I'll keep researching and talking to people and try to get some answers.

You sleep soundly tonight!

[Neco]

I think it is important to point out one thing here.

Methadone is not a sedative. It is an opiod painkiller.


While it is true people tend to associate sedative-like effects with anything that makes them feel plastered/lethargic etc.. It is really a common misnomer.

Opiods effect the Central Nervous System, by depressing some of its activities. This is why you might see Opiods mentioned alongside terms such as CNS Depressant / Effects.

There is some overlap here because a lot of different medications with different intended purposes, can have effects on the Central Nervous System. Although medications can be dangerously "sedating" in high enough doses, I don't really think its enough to label any CNS Depressant a "sedative", because traditional sedatives we think of (mainly Benzo's like Xanax, Valium, Ativan etc) are intended to calm and soothe the CNS to the point where the person can calm down and relax, or sleep is induced.. Mainly advantageous to reducing physical or mental stress beyond what is concerned normal.


Methadone in particular can produce heavy CNS Depressant effects in a given person, especially if they do not have a very high / sustained level of tolerance. Some opiates just work this way. Propoxyphene would be similarly high on the list of adverse CNS effects, despite the fact it is at the opposite end of the spectrum from Methadone (i.e extremely weak in regards to painkilling efficacy ).

You should never drink while on Methadone, especially if you are easily sensitive to changes of how a drug is working in your system. Even a couple of sips of wine could be enough to do serious harm. It's just not the same as popping a couple Vicodin and having a beer.

[doety]

Thanks, Zach. I could immediately feel the effects of even that tiny bit of wine. Never again. Thanks for the info -- and yes, I've figured out that I must be especially susceptible to this stuff. Otherwise, I'd be hearing a lot about this on the discussion board.

Ann -- I went to CPAPtalk.com and it was helpful (thanks).
I'm now trying to run down any clinics that specifically treat central apnea. I want someone to look at what's happening and give me a treatment plan. Of course I"m looking in Denver, but so far, no luck. Just like the wonderful Dr. B. you saw in California, I've decided I'm willing to do whatever it takes to solve this. I don't want to live like this, and even if it doesn't kill me, I think it probably hurts my heart.

[doety]

I was so down on Friday morning (after the bit of wine), finally I'm seeing some hope. When I tried to get a referral to a Kaiser neurologist who knows about central apnea, I was told "they all treat everything, including RLS and central apnea." Obviously, that wasn't true. I wrote a bunch of people, as I said in the last post, and got some wonderful people calling me back this morning.

A nurse at the Robert Johnson center in New Jersey talked to me for a long time and said "Of course sleep apnea and central apnea are different and you need different machines." After we talked, she encouraged me to find help closer to me, which makes sense, but said: "If you can't find help, you come here and we will help you." Then I talked to an incredibly knowledgeble nurse at Porter Hospital here -- they started their sleep clinic 6 days ago.
He was going to put me in an appointment this Thursday until he realized I was with Kaiser HMO, and that I can't go outside the system.

So, my task now is to be the squeaky wheel with Kaiser and get treated. The Porter guy talked to me about that for a long time. He said I should get an in-hospital sleep test to confirm the central apnea diagnosis. If that's right, he talked about the AVS (I think) or bi-valve machines. He said they cost four times as much as the CPAP. And get help in getting off Methadone and onto something else for RLS.

Of course I'm afraid Kaiser docs will think I'm a hysterical hypochondriac (sp?). God -- I even wrote a book about how you have to be your own advocate when you're facing surgery, but standing up for yourself is so hard. But I'll do it, and will get back here and tell you how everything went.

Thanks for all the help. d.

[ViewsAskew]

You go, girl.
(and, man, do I know how hard it is to keep up that facade and keep pushing....)