Cpap use and muscle relaxants

I will be seeing my doctor - again but in the meantime, thought I would ask here. I am having pain in several joints that is causing me to wake up often in the night. I am looking at a night time pain med with a muscle relaxant. I take a lot of pain medication already and have been using Tylenol Arthritis at night. It doesn't help a lot so was wondering if the Tylenol nightime pain with a muscle relaxant would help. I am wondering, though, if I should not take a muscle relaxant when I have sleep apnea and use cpap.

Any experiences out there?

Thanks.

alot of tylenol over a long period of time is definitely not a good idea. a real muscle relaxer prescribed by a doctor is probably better.

I had this discussion with my sleep doctor's PA 3 years go because of my arthritis.
Muscle relaxers are the worst offenders in making obstructive sleep apnea worse...those collapsing airway tissues "relax" more with muscles relaxers.
Opiates aren't great but not as bad as an offender as muscle relaxers.
When I broke my wrist last year and had to have the surgery and needed Percocet...I didn't see any huge changes in my reports. I just let the machine do its job...the APAP at the time.
The PA said she would rather see someone take an opiate for the pain instead of muscle relaxers...even with the possible addictive properties of the opiate.

I personally don't like the idea of opiates all the time but sometimes they are needed. So I do have some for those times.
After more discussion we added a low dose of amitryptiline to help me sleep with the pain. At low doses it is offered for people with fibromyalgia like symptoms. I am talking really small doses...like 10 or 20 mg.
I found that it helps me a lot with letting me sleep "through" the pain. Otherwise I would wake up 20 to 30 times a night with every little movement causing pain.
You might discuss that med option with your doctor. Non addictive and doesn't make the collapse of the airway worse and is really pretty benign at the lose doses. Taken early in the evening there is no morning fog or hang over.

Hey Pugsy! Your experience in here is invaluable! I am already taking Morphine for the pain (have for a lot of years). The dose goes up an down but I have never gone above the prescribed dose except during flares. I am able to get down BELOW the prescribed dose pretty quickly after the flare subsides. My experience with the morphine is the same as yours - no real difference in my cpap data.

I will be seeing my doctor this week and will discuss all these possible options. In the meantime, I wll continue with daytime naps to help me get enough rest - always with my cpap of course.

Thanks!

You know in your situation...good sleep is worth the added risk IMHO and if me...if I were in your shoes and something as benign as amitryptline didn't help...and muscle relaxers would...I would take the muscle relaxers and let the machine do its job. The worst that would happen would be more collapse of the tissues and you have APAP machine to deal with it if additional pressure is needed. Just because they "might" collapse more doesn't automatically mean you would need more pressure. If the possible additional collapse of the tissues is well prevented...who cares. It isn't like you can go without the machine otherwise.
Sometimes we gotta do what we gotta do. It isn't ideal but we don't always get "ideal" to deal with do we?
The affects of poor quality sleep are worse than letting the machine do its job and taking something to help get that sleep.

A muscle relaxant relaxes muscles -- if you have pain from degenerative joint disease or disc problems I can't see what a muscle relaxant will do. If you have spasms in the back muscles yes. Joint pain, no. That's where other pain relievers should be used.

And if you have an auto machine, it should compensate for drug use (incl. alcohol), but it may not work as well or as quickly than if the drugs were not used.

Talk to the MD.

What happens in degenerative joint disease is that the muscles tense and stay tense because of the joint pain, and then the muscles are painful as well since they don't relax. That's why I was considering a muscle relaxant in addition to my regular pain meds.

You make some more very good points here Pugsy. With just my pain meds on a "normal" day, I maintain an AHI of 1 or below most of the time. Since this flare began I have had AHIs up to 5 because of waking in pain several times during the night. This morning it was 3.5 - not too bad.

The flare will probably pass -as they always do, but in the meantime I need my rest. We do what we gotta do! As you said, we don't always get "ideal" and the effects of poor quality sleep really mess up a person's life!!

I'll certainly be talking to the doctor on Monday. Until then, I'll do what I gotta do!!

I take 30 MG of amitryptiline at night when I go to bed and also take 200 MG of celebrex twice a day for my arthritis. The amitryptiline works quite well for the low grain pain at night. I can thank Pugsy for the amitryptiline.

Thanks for sharing your experience with this Squid13. I really appreciate it. I'm sure going to be looking into amitryptiline for my situation!

I have two degenerating discs in my neck, that over the past 3 months have been giving me a lot of trouble.

I have tried Flexeril, valium, and tizadine, with the last being the most effective with helping to make me relax enough to get to sleep. As for the pain relievers, NSAIDs and tylenol help some, but I try to stay away from the big guns like pecocet or valium as much as possible, and living in the soon to be police state of Ohio, it seems like you need 5 forms of ID, a note from your doctor that you "really" need narcotics for pain and are not going to sell just them on the street.

I have looked at my numbers and nights that I do not use the relaxers - my numbers look worse, most likely as I am moving around more and inducing a whole bunch of "false" centrals. If I am am relaxed - the cpap will keep me open anyway, while narcotics can do more to depress the drive to breathe.

I use a mild muscle relaxer sometimes. Flexeril 5mg or 10mg. My doctors know about it and don't seem to have a problem with it. I do have an auto machine with 11-17 setting, so it may have to work harder when I use the flexeril.I use it when I am more tense than usual or have back pain. I have also been more tense, especially while sleeping. And over time, it builds up, and a muscle in my back will clamp down on the sciatic nerve. Pain killers don't help at all, but the muscle relaxer can usually free it up within a couple hours of the first hint that it is getting bad again. I have also found that it helps me sleep better, so I will use it sometimes when traveling. I don't sleep well in hotels, so it can help me get a good night of sleep when I am already down on sleep and need a really good night. I also used it a couple nights during my first week of cpap to help me sleep better with it. My machine has only reach 17 eight times in 4 months. And my ahi has gone over 5 less than 10 times. It is usually under 2 and often under 1. So, the machine is doing its job despite any medications I have used.

I think it would be more of a concern if the machine was unable to deal with additional problems (especially if there is no data to confirm whether it is handling it well or not). . And that could depend on the individual as well as the pressure settings. Some people may simply have more apneas. Some people may need a higher pressure level to handle them, and some may not. So, the machine may already be set to a pressure that can handle. Some people may need to use auto (or set the high enc higher) to handle if. If the machine has data, then it can be reviewed and adjusted as need.

just to add my 2 cents in on this. I take Tizanadine at night and have no problems with it. My leak numbers are zero. and my AHI is 0.02--so try something lihe that if you are in constant pain. I have chronic hip muscle pain and I am a side sleeper. The Tizanadine makes me sleep like a baby. everyone is different and opinions vary. I sure would steer away from the OPIATE family as that is asking for trouble there. and by all means stop taking all the Tylenol--your liver will thank you for that!
Carrie

Acetaminophen works great for me. The VA says no more than 3000Mgs a day and my private family doctor says 2000 mgs a day. If you are a non drinker their should be no problem if you use the higher limit.
Both of these Doctors refuse to dispense anything else for arthritis .When I read the Physician Desk's Reference for some of the miracle drugs. I can understand why they say that.

Bobby269 - I am assuming you have Osteoarthritis and not Rheumatoid Arthritis, or any of the other over 100 types of arthritis. Tylenol works pretty well for Osteoarthritis but more is needed for Rheumatoid. They are very different. The Tylenol is supplementary
to all the other drugs I take for RA to deal with the pain and I never take more that the recommended amount per day.

Sleeplessinaz - Tizanadine is one I have not heard of. I will mention it to my doctor as well. I have been taking morphine for many years, as I think I said in the first post. I didn't go back and look. As for the Tylenol, I have a liver function blood test done every 3 months for another RA drug I take and it is always normal - no liver problems in the 20+ years I have had RA. I have been taking morphine for almost all that time as well. I can go for long periods on just a very small morphine dose and no Tylenol but then a flare hits and I have to up the morphine dose some and add Tylenol - Not something I want to do but one has to do what one has to do to keep functioning. I don't take any of these drugs, except the Tylenol, at bedtime because of my sleep apnea.

I don't like the possible side effects of ANY drug but life is what it is.

Hawthorne the tizaninadine is new. I wake up refreshed and not ith a hang over like with some other muscle relaxers.google it and ask your doctor about it. Yes we all do what we have to do. I work full time so I have to get up every morning and hit the ground running! Lol!

Good luck.
Carrie