Sleep apnea and opiod's-Major dilemma!

[citrus cactus]

I have moderate sleep apnea and I take 60 mg of morphine sulfate 2 times daily for severe pain in my face and have not had dosing changed so my body should be used to the medication. I do have the kind of exhaustion that has turned my life upside down. I also take 20 mg of amphet. and Nuvigil and if I am lucky enough to complete an entire week working, I can sleep for 16 hours and more at the end of the week. WOULD ANYONE with sleep apnea be willing to share how long they can sleep? IT might not sound important but it really would benefit me. Background: I am 48 with 2 kids and my wife is an oncology nurse. Most of her patients have more energy than me and I am having a really hard time understanding this much fatigue. I have done some research and do not seem to have enough of the symptoms for "chronic fatigue" or fibro myalgia. For those who reply, Thank you so much!!!

[Sleeprider]

Citrus, your opiate use can cause serious central apnea problems in people formerly diagnosed with obstructive apnea. If your sleep study diagnosing moderate SA did not evaluate your condition with the use of your current drugs, you could be experiencing some pretty serious issues with central sleep apnea which will not respond to conventional CPAP therapy.

Are you currently using CPAP or other PAP therapy? Your profile does not indicate you are treating your apnea. If you are currently being treated with CPAP please identify the make and model of device you are using.
Have you told your doctor of these issues with extreme fatigue, and discussed the complication of existing apnea?
Do you have access to a recording oximeter to determine if you may be having serious oxygen desaturations that contribute to your fatigue?

What is normal for those of us with sleep apnea is not particularly relevant to someone with SA and taking your drug regimen.

[eseedhouse]

Your profile says that you are not using any kind of CPAP machine. Is that correct? If so taking opioids with untreated sleep apnea can be quite dangerous. Getting on a proper positive air pressure system for sleeping can make this obviously necessary use in your case quite a lot safer. You should be using a modern data capable *PAP system and you should be checking it's effectiveness every morning and adjusting it to meet changing circumstances. With a properly function CPAP, APAP, or even ASV system your necessary use of these pain medications can be a lot safer because it may likely prevent them from making your apnea worse if properly adjusted. Chronic pain sucks, but in a person with apnea already the pain medications can shorten your life.

Get that apnea treated properly. Take charge of your treatment and track how well or badly it is working. If you do then using the pain medications, while not ideal, will at least make it possible to use them more safely.

[DaveD]

Just a question - is your face pain due to trigeminal neuralgia?

[citrus cactus]

I have tried cpap several times but the pressure of straps caused pain and I also experienced many of the common complaints. I have also tried oral appliance and later found out it was not even approved for apnea. I have had many different procedures and surgeries to try to reduce/stop the pain but no luck yet. I have discussed with my Dr. but I do not think she can grasp the extent of the fatigue. My dad was a Dr. and had the ability to listen and understand what his patient's were communicating. Unfortunately my choice in dr.'s so far has not been beneficial. Thank you for replying!

[Possum]

I can echo many of the other members' concerns regarding the combination of sleep apnea and opioid pain relievers. A few months ago I had such an awful case of bronchitis that my doctor prescribed a hydrocodone (Vicodin) based cough syrup. When I used it at night, my central and obstructive apneas skyrocketed, and my machine struggled to keep me breathing properly. That said, I hope you will consider going back on xPAP, as it is especially important now with the constant administration of such a powerful drug.

To answer your question proper, the most I have ever slept with my CPAP is about 12 hours. It was over the holidays when we had the luxury of Grandma and Grandpa willing to let my wife and I sleep in while they took care of our 2-year-old. I was also abnormally exhausted at that time due to the normal pressures of the holidays. I would say normally I can sleep up to 8 hours if no alarm is set, then I'm usually refreshed and ready to start the day because my sleep quality is so much better with CPAP therapy.

[trish6hundred]

Hi citrus cactus,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you.

[Sleeprider]

Citrus, do us a favor and pick up a recording oximeter that can monitor and record your oxygen levels as you sleep. This could save your life if you are having narcotic induced central apnea or aggravated obstructive apnea. The symptoms you're reporting are serious, and no doctor can ignore evidence of serious oxygen desaturations in sleep. Your wife should have access to this simple inexpensive monitor, and might be able to check one out of her oncology department for a night.

I'm sure you must be seeing a chronic pain specialist. You need to make him aware of this complication.

[Sleeeppp]

I agree totally - all the apneas need to be addressed. Your doctor should talk you through the options, process and allay any concerns.

After 4 months, Im still having high centrals and insomnia (I have complex apnea) and the specialist says "she's happy with my cpap 'progress'". So, out with the phone book - get a new sleep consultant!