best painkillers to use with sleep apnea?

[nmevan]

hello fellow cpapers

I just had surgery on my neck a few days ago and I will be experiencing a great deal of pain for the next few weeks.
The docs prescribed 10mg of oxycodone (opiate) to be taken every 4 hours for pain.
Baclofen 5mg (muscle relaxer) every 6 hours for muscle spasms.
Tylenol 500 mg taken every 6 hours for pain.

I believe the opiates are increasing my apnea...which is already severe. I awoke in the middle of the night with the pressure from my bipap much higher than I ever needed it before...hence, it would cause the air to escape back out though my mouth and wake me up.
I suspect the muscle relaxer is doing the same on some level.
And I keep hearing that tylenol is bad for your liver.

Wondering...any suggestions on either different painkillers to use, or a safer way to use the ones I've already been prescribed?

thank you!

nmevan

[LSAT]

High doses of Tylenol over long periods of time would be bad for your liver. Short term is not a problem, however try to stay within the guidelines listed on the bottle. Tylenol will not help your pain as well as the oxy, but the possible side effects are fewer. As with any medication change....talk to your doctor first.

[hueyville]

I take oxycodone every day. 30 mg 6 times per day. No sleep issues with it but does depress respiration as all opiates do. A 10 mg oxy taken w Tylenol exact same as taking percocet. Imagine he separate so easier change doseage of one without the other affected. Take baclofen too. Very low power muscle relaxant no worries with it. As this is probably short term would not worry excessively about.effects on apnea. Be glad they can fix.your neck. My only option is fusion from c1 through c4 thus no turn neck again. Living with the pills.instead.

[JamesW6175]

Check out the OTC Walgreens Arthritis Pain Reliever , it is 650 mg of Acetaminophen. I found out that this is better than other OTC pain relievers due to the higher level of the pill/caplets at 650 mg while the other OTCs only go up to 500 mg for the extra strength.

[SleepyToo2]

As others have noted, if you do go for the higher strength Tylenol (or acetaminophen, or paracetamol if you live in the UK; they are all the same thing), stay within the dosage described on the bottle. The warnings are there for a reason, and should be listened to. Too much of this stuff is bad for your liver - and for you if you choose to ignore the warnings.

[Pugsy]

Talk to your doctor about your concerns and how to best manage the discomfort and potential ramifications of using the opiates and the muscle relaxer.
Opiates will likely suppress the respiratory system a bit.
Muscle relaxers cause the tissues to relax and more likely to obstruct the airway and thus maybe need more pressure.
The time will pass and your needs for them will lessen but in the meantime you need to sleep.

Perhaps timing of the doses can be altered a bit to lessen the potential impact.
Couple of years ago I broke my wrist and it require surgical intervention. It hurt bad for quite a while and I was taking some opiates for pain control. It was either that or not much sleep due to the pain. I had maybe a handful more centrals that I normally see and yes my pressures were a bit higher than I normally might see but the time on the pain meds wasn't all that long.

There is always a risks vs rewards situation when it comes to these types of meds.
The muscle relaxer is probably a bigger factor because of the relaxing of the tissues and thus increases the chance that the airway tissues will also get more relaxed and floppy and that's when the machine wants to increase the pressure.
The opiates may cause a person to have a few more centrals or very shallow breathing but airway isn't collapsed so maybe a few more centrals. My sleep doctor told me that muscle relaxers were normally the most problematic of the 2 types of drugs when it comes to OSA.

The best thing is to discuss your concerns with your doctor and then maybe the 2 of you can come up with a plan that lessens the impact of the meds on your OSA and still allows you to get the sleep you need.
Maybe a slight dosage modification or delivery time modification might help.
It won't be long and you won't need the meds anyway.

[Vader]

The drugs that you mentioned shouldn't pose a problem in the short term, however keep an eye on your acetaminophen dosage because too much can cause problems, and the Oxy most likely has acetaminophen (sp.?) in it.
I've taken Oxycodone for neck and spine, and it's not something you want to stay on long term, if possible. Oxy is highly addictive.

[Thewino]

Hello nmevan,

All opiates will suppress your respiratory rate. This is just a side effect of the medication. To be clear, oxycodone by itself does not contain any Tylenol or its generic name, Acetaminophen.

The recent thinking has been that 4 grams of Tylenol per day would be the maximum amount allowed before liver damage could occur. Now, some physicians and some publications are recommending a maximum of only 3 grams of Tylenol in any 24 hour period to protect your liver.

1 gram is equal to 1,000mg.

The current dosage that your physician has you on is 500mg every six hours or four times a day. This is 2 grams every twenty four hours so, as long as you don't take any other medications with Tylenol (cold meds, cough medicine) or drink alcohol, which we all know is very hard on your liver, you are within the recommended maximum daily dose of Tylenol.

As far as opiates and CPAP, all our bodies are unique so one medication is not better or worse than another. When you are recovering from surgery, getting the appropriate amount of sleep is extremely important as your body uses this time to repair itself. I am not dispensing advice but, if it were me, I would not be worried in the least if my AHI increased a little bit due to the post operative medications. I have an Autoset machine and would set the ranges appropriately.

Plus, please remember that this is a very limited time-frame we are speaking of. I, personally, wouldn't be worried about the CPAP for this reason.

Godspeed on your recovery!

TheWino

[RandyJ]

I have read that latest guidelines for opiates have contraindicated them for long term use for pain relief, so it is likely that your issue will be shortlived.

I took Flexeril (muscle relaxant) once and my normal AHI of 0.3 shot up to over 10... as Pugsy says it relaxes the tissues in the airways, so more events are likely. If you are using an auto range and your upper limit is high enough, maybe this can be mitigated somewhat, as well as moving the dosage (as Pugsy says, with dr approval) as far from bedtime as possible.

[Vader]

To be clear, "Oxycontin" does NOT contain Tylenol, but Percocet, and Endocet DO contain Tylenol.
So it depends on which formulation of oxycodone that you have been prescribed, as to whether it contains Tylenol.

[nmevan]

thank you to everyone for your replies!
I will most likely continue with the meds I have been prescribed, but I will talk to my doc and brainstorm about the timing of the meds.
I'm somewhat relieved to hear that the dosage of tylenol I'm supposed to take is low and should not cause liver damage, but there are always some out there that think any is too much.

thanks again for taking the time to help!

nmevan

[khauser]

I have read that latest guidelines for opiates have contraindicated them for long term use for pain relief, so it is likely that your issue will be shortlived.

I took Flexeril (muscle relaxant) once and my normal AHI of 0.3 shot up to over 10... as Pugsy says it relaxes the tissues in the airways, so more events are likely. If you are using an auto range and your upper limit is high enough, maybe this can be mitigated somewhat, as well as moving the dosage (as Pugsy says, with dr approval) as far from bedtime as possible.

I haven't ready that ... I have read that doctors, as a group, are concerned that long term usage is tied to the abuse of pain relievers, but that hasn't led to a consensus on how to deal with long term pain patients (such as myself).

The problems are:
1) Long term use of acetaminophen at ANY dosage is bad for the liver (LONG term ... I'm not saying anything about short term)
2) Long term use of NSAIDs at a dosage adequate for pain relief is bad for the kidneys and gastro-intestinal tract (the latter due to bleeding)
3) Long term use of opiods has a potential for abuse. Interestingly, all of the BAD things we hear about opioids stems from ABUSE of opioids, not from proper use. Of course there are side effects, but if you take it per doctor's orders and don't mess with the dose, the worst side effect you'll likely encounter is constipation, and that can be dealt with (I'm excluding issues such as allergic reations).

Unfortunately, a rather large population of otherwise legitimate opioid-treated patients DOES abuse the drug. Heck, the same is true for acetaminophen and NSAIDs ... people take more than they are supposed to because we're in an age that believes there should be a quick fix for anything and everything.

All of that said, regarding the OP's question:
1) Opioids CAN lead to a need for a higher pressure, but the Baclofen is probably more of an issue in that regard. Another poster has already pointed out that opiods reduce respirations ... but that means you breathe less often and perhaps less deeply, NOT that you're having more obstructions. Your machine wouldn't treat reduced breathing in any way. An ASV machine, I believe, would do so, but you have a BiPap.
2) Tylenol for a short time isn't an issue. 500mg 4x/day is 2grams for a full day, which is considered safe if you have a healthy liver. BE VERY CAREFUL to examine every other OTC and prescribed drug, as acetaminophen is in a great deal of them, and MOST overdoses of this drug are quite unintentional.

Regarding pain treatment in general: Take all of those medicines as prescribed. If it says to take it every x hours, do that. It is much harder to treat pain when it gets severe then it is to keep it from getting severe.

ON THE OTHER HAND, if your meds say "as needed", then don't take them until you notice the pain getting worse.

I believe when prescribed for acute needs like this you typically get a very few days worth of narcotics. If not abused you won't even notice it when you stop.

Hope this helps...

[RandyJ]

I haven't ready that ... I have read that doctors, as a group, are concerned that long term usage is tied to the abuse of pain relievers, but that hasn't led to a consensus on how to deal with long term pain patients (such as myself).

I may be thinking of this interview I heard on Fresh Air on NPR: http://www.npr.org/2013/05/29/186927127 ... ld-of-hurt

Somewhere in the interview I seem to recall mention of new studies that indicate that most of the opioid class of pain meds do not seem to be effective long term due to patients getting used to them and needing higher dosages/more frequent dosages, dependency etc and as a result new guidelines would be implemented to change prescribing practices.

I hope I am recalling the source etc correctly.

[khauser]

I haven't ready that ... I have read that doctors, as a group, are concerned that long term usage is tied to the abuse of pain relievers, but that hasn't led to a consensus on how to deal with long term pain patients (such as myself).

I may be thinking of this interview I heard on Fresh Air on NPR: http://www.npr.org/2013/05/29/186927127 ... ld-of-hurt

Somewhere in the interview I seem to recall mention of new studies that indicate that most of the opioid class of pain meds do not seem to be effective long term due to patients getting used to them and needing higher dosages/more frequent dosages, dependency etc and as a result new guidelines would be implemented to change prescribing practices.

I hope I am recalling the source etc correctly.

I'll have to look in to that. There is a problem with opioid treatment and tolerance, which basically means the dosage that used to work yesterday isn't sufficient today, but tolerance is not usually an ever-growing phenomena in a patient that doesn't abuse the drug. It can APPEAR that way if the patient is not properly titrated from the start because the patient asks for more and more as the pain refuses to subside. And tolerance leading to addiction is a problem if the drug isn't GOING to work without reaching fatal dosages. So there certainly is danger to opioid use (as with any medication).

But the strange yet true fact is that if you have a patient that is NOT abusing the drug and is well-treated by the drug, said patient is safer on that drug then on either acetaminophen OR an NSAID long term.

There are some new drugs in the pipeline that may make opioid use unnecessary at last ... they are very promising, and also very new.

Obviously I have personal reasons for keeping such a close eye on this issue. I would not be a productive member of society today without the care of a doctor in treating my chronic issue. It's been decades since my back surgery and the resulting mess in that area. I started with NSAIDs, and they worked REALLY WELL. I wasn't taking more than I should, and in fact didn't need to ... but after many months of that I suddenly got told I had to stop (darned lucky that I see the doctor for other issues). My kidney tests were showing two very UNHAPPY kidneys. Fortunately no longer term damage occurred.

I've always been afraid of acetaminophen, and my doctor agreed that drug alone wouldn't help and long term would be equally bad. There weren't a lot of other choices.

Despite a steady treatment plan in place for decades (that did not escalate once we found the right dose), I would be happy to leave this medicine for something else if it becomes available. There's a lot of issues around opioid use, especially these days when pharmacy's are afraid to stock it.

[hueyville]

I have been in pain management for 7 years. Oxycodone/roxycodone is the best and least side effect pain killer I have used to date. No other junk like tylenol or ibupropben in it. Just straight pain whacking opiate. Best part is it does not make me high or any more stupid than as delivered from the factory. A little adjustment time and now all good.