“Everything you need to know about CPAP – But were afraid to ask!”
founders of the Sleep Apnea Patient Support Group 19 years ago), ably assisted by Bill Stoll of Timberlake Respiratory Care gave an excellent presentation to the Support Group at the spring meeting on “Everything you need to know about PAP.”
Lori traced the history of CPAP therapy from what was originally called the “Pickwickian Syndrome” (named after “Joe” in the Charles Dicken’s novel, “The Pickwick Papers” who fell asleep in almost any situation) up through the development of PAP (Positive Airway Pressure). Lori also covered the variations of PAP and their specialized uses. This was followed by an informative Q & A session.
HIGHER RISK SLEEP APNEA WITH USE OF OPIOID PAIN MEDS
Opioid-based pain medications1 may cause sleep apnea, according to an article in the September issue of Pain Medicine, the journal of the American Academy of Pain Medicine.
“We found that sleep-disordered breathing was common when chronic pain patients took prescribed opioids,” explains lead author Lynn R. Webster, MD, from Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah. “We also found a direct dose-response relationship between central sleep apnea and methadone and benzodiazepines2 an association which had not been previously reported.”
Opioids, effective medications for chronic pain treatment, are often used for cancer patients, but are now gaining widespread acceptance as long-term therapy for chronic pain unrelated to cancer. An increasing number of patients with nonmalignant chronic pain are receiving around-the-clock pain relief through opioid therapy.
The researchers studied sleep lab data on 140 patients taking around-the-clock opioid therapy for chronic pain to assess the potential and prevalence sleep apnea in opioid treated pain patients. All patients were on opioid therapy for at least six months with stable dosing for at least four weeks.
The investigators say that their results show a higher than expected prevalence of sleep disordered breathing in opioid treated chronic pain patients. Obstructive and central sleep apnea syndromes occurred in the studied population at a far greater rate (75%) than is observed in the general population, where obstructive sleep apnea is known to be underdiagnosed but has been estimated at roughly 2% to 4%. Central sleep apnea is estimated at 5% in people older than 65 years and from 1.5% to 5% in men less than 65 years old. People who stop breathing during sleep because of faulty brain control have central sleep apnea as opposed to obstructive apnea, which is triggered by obesity and/or other health problems and accompanied by loud snoring.
The investigators comment that the absence of crescendo-decrescendo breath size commonly associated with central sleep apnea suggests that the central sleep apnea mechanism is different for people taking opioids than the general public. They suggest it could be related to the direct effects of opioids on the part of the brain that controls respiration.
The authors also note that if opioid medications increase sleep apnea risk as their research suggests, then chronic pain patients who are prescribed opioids have a higher risk of contracting sleep apnea.
“The challenge is to monitor and adjust medications for maximum safety, not to eliminate them at the expense of pain management,” Dr. Webster concludes.
1 The American Academy of Family Physicians notes that opioid drugs include those produced for pharmaceutical purposes and those for recreational purposes. For example, opium and heroin are street opioid drugs. Other opioid drugs, such as codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxycontin, oxymorphone, paregoric, sufentanil and tramadol, have medical purposes.
IMPORTANT CHANGE IN HOW YOU GET CPAP SUPPLIES
Effective July 1, 2013 Medicare has changed the manner in which those on “Original Medicare” obtain CPAP equipment and supplies if you live in certain areas, In order to receive Medicare reimbursement you need to obtain these supplies from a “Medicare – Contract Supplier.” The schedule for replacement of CPAP equipment and supplies remains unchanged only the manner in which you receive them. Information regarding this program was mailed to eligible Medicare patients. If you did not receive the material in the mail of have questions go to www.Medicare.gov/supplier and enter your ZIP code or call 1-800-633-4227.
Trauma and Sleep
(from National Sleep foundation)
Stress from a traumatic event can often lead to a variety of sleep problems. The result can be insomnia, bad dreams, and daytime fatigue caused by sleep disturbance. Some people with sleep problems and anxiety have posttraumatic stress disorder, or PTSD. PTSD is a reaction to a traumatic stressful event resulting in a feeling of a loss of control and an inability to help yourself in a bad situation. It’s often experienced by people who are in situations that range from combat to rape, but it can be caused by a variety of events.
When the body is overstimulated, the brain is flooded with neurochemicals that keep us awake, such as epinephrine and adrenaline, making it difficult to wind down at the end of the day. The neurochemicals remain present in the brain and can interrupt your normal sleep cycle. The following are common sleep problems following a trauma:
Flashbacks and troubling thoughts can make falling asleep difficult.
The victim might feel the need to maintain a high level of vigilance, which can make sleep difficult.
For those who experience violent situations, nighttime and darkness can, in and of themselves, bring about added anxiety and restlessness.
Taking naps during the day might be helpful, but, if overdone, can also interfere with your efforts to sleep through the night.
Once asleep, nightmares can frighten a survivor back to consciousness, and getting back to sleep can be very difficult.
For those who are experiencing temporary sleep problems, there are a number of things you need to know which can help with insomnia, bad dreams, and daytime fatigue. Sleep experts recommend trying to reduce feelings of stress, especially before bedtime. Don’t watch the news right before going to bed. Avoid coffee in the afternoon and evening. Take a warm bath or soak in a hot tub before bedtime. If sleep problems persist, see your doctor, who can prescribe medications that will help you sleep but won’t make you groggy in the morning. Here are some additional tips that may prove helpful:
Sleep in a location where you will feel most rested and safe. While the bedroom is optimal, it may not be possible to rest there soon after the trauma if you experienced violence in that room.
Create an environment in which you can sleep well. It should be safe, quiet, cool and comfortable. While it often helps to sleep in a dark room, if keeping a nightlight on helps bring about a more safe feeling, then consider keeping the room dimly lit.
• Engage in a relaxing, non-alerting activity at bedtime such as reading or listening to music. For some people, soaking in a warm bath or hot tub can be helpful. Avoid activities that are mentally or physically stimulating, including discussion about your violent experience, right before bedtime.
• Do not eat or drink too much before bedtime and recognize the negative role that alcohol can have on your sleep.
• Rest when you need to rest. It is common to feel exhausted after a violent trauma, so you may need more rest or to rest differently during this time. Relaxing and resting for brief times throughout the day and taking short naps (15-45 minutes) may help.
• Go to bed when you feel ready to sleep. Try not to force sleep, which can add to the pressure of wanting to get to sleep. Developing the harmful habit of lying in bed awake for long periods when you want to sleep is counter-productive.