Wednesday, October 03, 2007

Opioids and sleep apnea

Opioids such as methadone are well known to cause central sleep apnea. Sleep Review Magazine reports a high rate of obstructive and central sleep apnea in patients who use opioids for chronic pain:
Sleep-disordered breathing is very common in patients who use opioids for chronic pain conditions, according to a report issued online September 6th by the journal Pain Medicine.
Of the 147 patients
on chronic opioid therapy who agreed to undergo testing, 140 had data available for analysis, the report indicates.
"The biggest finding was an extraordinarily high prevalence of sleep-disordered breathing in opioid-treated chronic pain patients," Dr. Webster noted. "Obstructive and central sleep apnea syndromes occurred in the studied population at a far greater rate (75%) than is observed in the general population."
The most common type of sleep apnea, seen in 39% of all patients, was the obstructive type, followed by central sleep apnea in 24%, central and obstructive sleep apnea in 8%, and indeterminate type in 4%.
The apnea-hypopnea index was directly related to the daily dosage of methadone, but not to that of other opioids (p = 0.002). The central apnea index was directly linked to the daily dosage of both methadone (p = 0.008) and benzodiazepines (p = 0.004).
It is interesting that in this study methadone appeared to have a greater effect on sleep apnea than other opioids.
I run a
suboxone clinic to treat persons addicted to opioids. I'll have to increase my monitoring of their sleep.

9 comments:

Plague doctor said...

Great post.Thanks .
@interesting health articles

ANDY said...

I HAVE BEEN ADDICTED TO PAINKILLER FOR THE BETTER PART OF 20 YRS AND STARTED TAKING SUBOXONE 5 MONTHS AGO. IT WORKS GREAT FOR THE PAIN PILL ADDICTION AND DEPRESSION THAT COMES ALONG, BUT I I BEGAN TO EXPERIENCE FRIGHTENING EPISODES DURING THE NIGHT THAT I SUSPECT IS CENTRAL SLEEP APNEA. IT STARTED 3-4MONTHS AGO AND ITSEEMS TO BE GETTING WORSE (4-5 EPISODES PER WEEK AND SOMETIMES MORE THAN 1 PER NIGHT). I SUDDENLY WAKE UP SCARED OUT OF MY MIND BECAUSE I CANT BREATHE OR CATCH MY BREATH,MY HEART IS BEATING OVER 220 BEATS PER MINUTE AND I THINK IM GOING TO DIE. IT TAKES ME ABOUT 30 MINUTES TO CALL DOWN ENOUGH TO TRY AND GO BACK TO SLEEP. ITS GETTING TO THE POINT THAT IM SCARED TO SLEEP. IS SUBOXONE CAUSING THIS OR WOULD THIS HAVE DEVELOPED ANYWAY? I'VE HEARD THE MACHINE DONT DO MUCH FOR THE "CENTRAL" SLEEP APNEA. IM CONSIDERING QUITTING THE SUBOXONE. IT LIKE TRADING THE WITCH FOR THE DEVIL. IS THYERE A REAL RISK IF DIEING WITH THIS? I'M A 42 YR OLD MALE IF THAT MATRTERS. ANY COMMENTS WILL BE APPRECIATED. THANKS - ANDY

Beth Donahue-Weedman said...

Hey Andy,
EXACT same thing happened to me. I got diagnosed last week with Sleep Apnea, and I know lots of ppl have it, but I have both Central AND obstructive. Left untreated this leads directly to Obesity, heart disease and diabetes. The culprit? Suboxone. My SleepDoctor said even if I lost 40 pounds and quit smoking (I know, I know) I would have this. Sleep Doc said the Suboxone is causing ONE of the kinds, and I beleive him because I've never been able to breathe at night since I started it. I CAN'T go off the Suboxone or I'll start looking for pills again. I told my BLEEPING Subox Doc I couldn't breathe, and he declared breathing difficulties" absolutely not be related." I knew he was wrong, and the sleep doc asked me right out of the gate if I was taking Suboxone. FINALLY, someone who agreed with me! I KNEW it was the Suboxone! Sleep Doc sent me home with a machine for 5 nights which showed I need a full ventilator to breathe with. The Sleepdoc reccomended the CPAPtalk.com forum to help me find a better price on the machine I need (I dont have Insurance). That Forum is wonderful, but not a lot about Suboxone & Apnea. Ideally, my Sleep doc and Subox Doc need to be working together, but again my SuboxDoc has a serious God complex and no one can tell him ANYTHING. The few times I have tried he literally starts yelling at me! It's insane, but with no insurance the list of docs I can see/afford is small, and only this guy had a spot open for me to get the Free meds.

Suboxone is the miracle, but very few Docs for some insane reason, are entertaining the possibility that the Suboxone could be related to breathing problems. I reccomend www.suboxforum.com as well as www.cpaptalk.com. It sounds like you have what I have and need to go see a sleep doc. Not sure how old this post is, but if it's really old maybe it will help someone else? Good Luck to you, buddy.

Amanda Barnes said...

Actually the first post sounds more like anxiety attacks. I would rule out sleep apnea though it's just I've suffered with panic disorder and I would wake up that same way. As of right now I'm waking up gasping for air and my partner is actually been watching me telling me I stop breathing. I have been taking methadone for 6 months and had no clue what so ever there was any relation until I started searching online. I'm not overweight and I don't smoke.

Amanda Barnes said...

I meant would not rule out. Sorry I was posting from my phone. I see my doctor tomm after banging my head against a wall trying to figure out why I'm sleeping all day and feel like I'm half dead. I've been going through this for two months and I'm very angry that the medtadone/ suboxone doctors haven't even thought to let their patients know of this risk. Methadone carries a risk of afib

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