Meds and Events

[ejbpesca]

Trying to get help with pressure settings I've had helpful experts on CPAP communities ask for my med list.  There is only one med I take each day but several I use as needed and they are needed often.

Not prying for your med list, but have you noticed a correlation between certain meds and AHI's?  How significant is the correlation?  Can meds render CPAP therapy useless?

[Synestheat]

Recall fails to remind me of any incidents in which CPAP / APAP (or xPAP for shorthand) machines consumed medications and were thereby rendered useless; however, medications taken by the user of an xPAP can certainly play a role in sleep quality for which an APAP, such as you indicate that you use, may make algorithmic adjustments in an attempt to compensate for those changes in medication-induced, sleep-related breathing patterns albeit within the constraints set for the APAP.  There are limitations.  For example, if someone with narcolepsy takes medication to stay awake and errantly takes that medication, dons their APAP, and settles in for a good sleep session, I would hazard a guess that the individual will be disappointed with the outcome because there is no way for an APAP to overcome the effects of that medication.

Medications have a half-life.  Medications can also have side-effects that can vary in occurrence and severity depending upon the individual; for some individuals, the side-effects can be diametrically opposed to those reported by others.  Sharing with others, whom you don't know, the list of medications you take can either be intimidating or reassuring depending upon one’s perspective; I'm sure the request for which medications you take was submitted with the intent of providing you with some directly applicable feedback that you could consider in your sleep therapy.  Sans any specific or anecdotal help from others, you will need to research your own medications, take note of how each medication impacts your therapy and decide from there; if you are diligent, perhaps within a month, a few months, or more, you can figure out what works best for you.  OSCAR has a great feature of Notes / Journal, where you could record this information for every night you sleep with the assistance of your APAP.  

xPAP therapy has been in my life for quite a while and has yielded beneficial results. Beneficial as they may be, xPAPs are not magic and the user will only get out of them what they put into using them.  In the not-too-distant past, I hit a long stretch of not getting any modicum of beneficial sleep no matter what I tried and the common theme of doctors, DMEs, etc, being unhelpful as reported by many in this community was consistent for me. It was taking a heavy toll and given that getting quality sleep was important, it was definitely moved up the priority list; only you can decide for you how important this is for you. 

Loathing the thought of posting a screenshot of OSCAR without articulating a goodly amount of contextual information, my approach involved searching and reading as many pertinent threads in these forums (right or wrong, I always assumed that the question had been asked on a prior occasion) and reading through the wiki topics for every nugget of information; sometimes, it can take a great deal of time for you to develop enough understanding for something simple to fall into place, which will yield greater understanding of interdependencies. Studying the OSCAR data of the previous night's sleep and making dedicated use of OSCAR Notes / Journal for months and months and months, I could see patterns emerge, topics to research, and make progress with gaining control over my sleep.  I logged everything I could think of into the Notes / Journal on a daily basis: sleep quality, cognitive quality throughout the day, my weight, what I ate and when, what medications I took and when, and on, and on, and on; I made a template that I could copy, paste, and update daily.

Every day, I would print the report from OSCAR with the Notes / Journal, etc., make handwritten notes, make use of a highlighter, color code the days with different colors of washi tape, etc.  The next time I went back to the sleep doctor, I had my 2 1/2” thick binder of information and my laptop with OSCAR; I also had reports from one of the “accepted” software applications that matched OSCAR perfectly just in case they wanted to have that argument.  That binder also included all clinical notes from prior visits so I could point out inconsistencies, every sleep study I've ever had, documentation of all of the things I had purchased or otherwise implemented to demonstrate that I took my sleep seriously and was putting in the effort, a list of any other medical issues that needed to be taken into consideration, and so on.  I was incensed after providing all of the pertinent information and after another sleep study, all of that information was ignored the doctor had prescribed a CPAP set to a pressure that was proven to be inappropriate and detrimental for me in the past. The doctor's office didn’t even want to open the binder to look and knew that I was serious and even commented that I likely know way more about sleep therapy than they do and certainly more than any other patient they had.  This enabled me to dictate medications that would be terminated and illicit help in other areas in which a medication may be indicated. More importantly, this enabled me to dictate the brand and model of APAP machine I was going to be prescribed as well as the granular detail of the settings, which I would then manage myself - they were literally writing the prescription as I was speaking.

Having a lifetime of breathing issues, anyone approaching me in a manner that might be suspect of compromising my breathing in any manner would be taking their life into their own hands.  When I learned from my data, notes, and forum research that many of my sleep-related problems were likely positional and the recommendation was to wrap something around my throat all night, I was aghast, but I ordered a soft cervical collar (SCC) with the attitude of “I’ll overcome the apprehension if it helps.”  It did.  Now, I  own several SCCs so that I can wash them and use them in rotation.  I was amazed at just how much benefit was gleaned from something so inexpensive.  Wearing them is now perfunctory and I get very irritated with myself when I forget.

Throughout this journey, which was a tremendous amount of work, the best thing that happened is that I TOOK CONTROL OF MY SLEEP AND MASTERED IT!  

If I don’t get a good night of sleep now, I can usually pinpoint why and I don’t get in bed frustrated with the expectation of another night of poor sleep.  There have been many other positive outcomes to this in other areas of my life that, directly or indirectly, have improved my sleep as well.  For example, nightly, I would be awoken by joint pain when I moved, especially in my shoulders and I resolved that issue without medication, just some dietary changes.  I never assumed that my pressures were the problem, but throughout this process, I was able to lower my max pressure by 3 cmH20, which was helpful and I addressed my full-face-mask (FFM) leaks and Large Leaks (LL) with the use of RemZzzs and positioning my head at the end of the pillow so the mask hangs over the edge of the pillow and isn’t pushed out of place by the pillow (learned from this forum).

It is your prerogative whether or not you share the medications you take.  If you choose not to share then you may need to use the approach described above to figure it out for yourself.  Given the half-life of those medications you state "are often needed" and the frequency with which you take those medications, you may need to consider them as being used daily for the purpose of sussing out their individual and / or interaction implications on your quality of sleep.  Thereafter, if you discern any of the medication(s) are negatively impacting your sleep, you may determine a different and more optimal timing for taking the medication(s) so they don’t have as much impact on your sleep, maybe you need something from your doctor to abate the side effects that impact your sleep, or perhaps posting an OSCAR report with a goodly portion of relevant accompanying information including the things you have tried with a sufficient amount of time to realize any results whether they be successes or failures may lead to the helpful responses your desire.

[ejbpesca]

Thanks for the reply.  I continue on trying to discover why my OA events go up and down.  My reports are a mess of variations in OAs and leaks with neither seemingly related. I can have 2 OAs with 32 leaks, or 15 OAs with 5 leaks.  I take two meds daily, but others as needed.  I have yet to correlate the as needed with events.

All the huge amount of graphic data on OSCAR has overwhelmed me so I'm using the Events list to see how things are going.

[PaulaO2]

Any medication that effects:

sleep
depth of sleep
sleepiness
breathing
brain activity
brain chemicals
coughing
throat
sinuses
etc
etc

I take a LOT of medications. Each time one is altered, I take a look at the previous two weeks or more OSCAR data and get a feel for what is my norm PRIOR to changing the medication. Then after at least 3 days, I take another look at the new data and see if there are any changes. Unless it is extreme change, I wait at least 7-10 days to form an opinion on how it is going. If just an adjustment of an already taking medication, I see a stutter for a few nights then it settles. If it is a new medication, it varies depending on what it is for and what its side effects are.

For example, each time we adjust or change my depression medications, I know I will get messed up sleep and sleep data. I also noted a difference when we adjusted my migraine preventing med (which is an anti-seizure medication).

So, yes, medications can and do change sleep patterns. We who have a sleep condition need to be aware of this and ensure our docs understand it, too. Autoset PAPs are best for this since they automatically adjust each night, every minute.

[ejbpesca]

Thanks for the reply.  Being old and with issues, I am prescribed so many meds it is crazy.  I'm overwhelmed, once I paid attention, to how my OSCAR reports jump around from a terrible report to a good one.  Got a good one last night.

I just changed out the head gear with new mask.  It seems to have made a difference.  The old one was way over due for replacement, as was the mask.  Folks here mention how long they use their gear.  Mine loses its elasticity and that means very reduced efficacy of therapy.

ALL new gear in a week or two.  Up for a new CPAP...Going for the AirSense 11.

[PaulaO2]

It is a good idea to sit down with your GP once a year and go over all of your medications. Take all the bottles with you. This ensures they know what all the other docs are prescribing, too. Always go to the same pharmacy if you can.

I have a spreadsheet of all my meds, in alpha order, that I take to all appts. I keep the "last updated" date on it so I can tell at a glance. I keep one in the bag on one of my crutches and another in a pocket on my service dog's harness. I include all OTC and "as needed" meds.

That list has columns for generic name (if applicable), brand name, dosage, and what it is for. So many medications now have "off label" usages.

Sorry for the diversion from your original question.

BUT, it does bring up: some day sit down at the computer and look up the side effects of each medication. Or ask your pharmacist for the patient sheets for each one. Make a note which ones, if any, effect sleep or breathing.

At the bottom I put my medication allergies.

If I had room, I'd add my conditions/illnesses/syndromes. If going to a new doc, I just print out my short medical history file and say "see attached" when they ask such stuff.

[PurpleOx]

I took an Ativan about a week ago right before I slept because I was getting really freaky nightmares right as I was falling asleep.

Not only does Ativan absolutely trash your sleep in the first place, I think my AHI score was significantly higher that night than usual. No leaks reported that night.

[greatunclebill]

my wife and i do the same. we each have a list in the computer with meds, conditions and doctor names. we update the lists and bring a copy to every doctor, every appointment.  we have alot of conditions and take alot of meds.

[Jeff8356]

I did something similar but with my iPhone. In my contact info is a place for Medical ID so I entered all my health conditions, allergies, medications, vaccinations, emergency contact, and GP. First responders can get to it in an emergency, and I always have it with me going to my Dr visits. Comes in pretty handy.

[PaulaO2]

I tried it with my phone but when I was in an accident and handed them my phone, they couldn't use any of it. They needed it in their hand to view the entire thing, not line by line or scrolling side to side or whatever. I've tried a bunch of ICE apps but none seem to really do the thing.

I do have Medic Alert and have that number easily available on my phone for me to hand over as well as several bracelets etc. But I don't always keep that med sheet updated.