Ativan, Sleep Apnea, and Bad Craziness

Someone searched my blog for Ativan with sleep apnea:

DO NOT TAKE ATIVAN IF YOU HAVE SLEEP APNEA.  It could kill you.

Ativan, also known as Lorazepam and Temesta, is a benzodiazepine; it is a narcotic.  It is used for the treatment of anxiety, insomnia and some other things.

The Physician’s Desk Reference (PDR) is the encyclopedia of all drugs sold over or under the counter.  When a drug has the potential to kill you, then the information in the PDR is printed with a heavy black box around it.  In the United Kingdom, Ativan has carried a “black box” warning for decades.  In the United States, it has not.  Maybe the FDA cares more about the drug companies making money than about you dying.

The problem is that Ativan interacts negatively with respiratory illnesses.  Sleep apnea is a respiratory illness, as are asthma, pneumonia and a bunch of other stuff.  Look Ativan up on Wikipedia and you’ll never again take the crap.  From Wikipedia:  The anxiolytic effects may also be detrimental to a patient’s willingness and ability to fight for breath.

• Sleep apnea – Sleep apnea may be worsened by lorazepam’s central nervous system depressant effects. It may further reduce the patient’s ability to protect his or her airway during sleep.

Ativan, like all narcotics, is also addictive.  I had insomnia from the antidepressants and the doctor prescribed Ativan.  When the Ativan “stopped working” then the dose was increased.  In fact, it hadn’t stopped working:  I’d become addicted to it and needed a higher dose to get the same effect.  I didn’t know any of this.

At the same time, I had been diagnosed with mild obstructive sleep apnea.  While taking Ativan, my sleep apnea became much worse.  I started out using a CPAP (Comprehensive Positive Air Pressure machine) with a pressure setting of 7, which is pretty mild.  A CPAP blows room-air at a steady pressure through a mask and into your breathing passage while you sleep.  Without the CPAP, your breathing passage collapses and you wake up to catch your breath.

I was always in trouble with the CPAP.  I’d go back to the sleep lab several times a year and every time they would discover that the CPAP pressure needed to be re-set up, down or sideways.  A heated humidifier was added to the CPAP and that provided some relief but didn’t fix the problem.  Then I was switched to a BiPAP, i.e., a Bi-level Positive Air Pressure machine.  A BiPAP, instead of having steady pressure, has two settings, one for inhalation and the other for exhalation.  The BiPAP was better than the CPAP but I was still having intolerable problems.

Having bipolar disorder and sleep apnea is a bitch.  Failure to get enough oxygen to your brain while sleeping can trigger a depressive shift.  I’d get suicidal because the sleep apnea wasn’t being properly treated.  The big problem here is that the study of sleep disorders started out in psychiatry but somewhere along the line the pulmonologists decided to claim it as their own.  Now, if your sleep disorder is causing depression, your pulmonologist will not treat you, saying it is a problem for your psychiatrist, and your psychiatrist will not treat you, saying you need to see a pulmonologist.

Psychiatrist Dr. Nasri Ghaly resolved the problem by going to Stanford University to study sleep disorders, then opening his own two-bed sleep lab.  After he came back from Stanford he put a pad of questionnaires about sleep problems on the receptionist’s desk and told her that everybody who walked through the door was to fill one out.  He was shocked at what he found:  patients whom he’d been treating for psychiatric problems for years were reporting sleep issues that they’d never told him about.  Doesn’t everybody know that if you aren’t sleeping well then it can cause you to act crazy?  Tell your psychiatrist if you have sleep disturbances!

Well, anyway.  I was having constant trouble and Dr. Ghaly had not yet gone to Stanford.  I had seen a cardiologist who had tested me for some breathing problem but hadn’t reported out the results.  The pulmonologist refused to see me until the cardiology results were in.  I was waking up in emotional torment, not to mention suicidal, in the middle of every night.  Finally, the strategy I used was to go the Emergency Room.  When you are in the ER, you immediately go to the top of your physician’s list of problems to be solved; he’s under enormous pressure from the ER to get you cleared out.  The ER physician—actually, a very nice physician assistant—called the cardiologist and pulmonologist and basically let them know they had to fix my problem NOW, and they did.

The cardiologist read the test results and cleared me, then the pulmonologist put me on an auto-BiPAP.  I did not know there was such a thing until that moment.  A regular BiPAP has two pressure settings; an auto BiPAP is controlled by a computer chip that re-sets the pressure with every breath.  It also has a SmartCard that electronically records a lot of data about how you use the machine.  When we pulled the SmartCard and had it read, what Dr. Ghaly and I discovered was that I had unstable sleep apnea!  Most people do okay with their machine on one setting for years; there’s no change in their usage and it doesn’t need to be re-set.  What we found was that my usage was changing during the course of every night.  My pressure might range from 12 to 21 in a single night.

I went through about five years of constant torment because my sleep apnea was neither properly diagnosed nor properly treated—not to mention that it cost the taxpayers upwards of ten thousand dollars.  I have been using the auto BiPAP for about three years now and have not once had a single problem.  I haven’t seen the pulmonologist, been back to the sleep lab, or gotten suicidal from poor oxygenation while sleeping.

There remains a single question:  If I had not taken Ativan, would I now be sleeping with a mask over my face every night?  There’s no way to tell but I for damn sure would never take Ativan again and I hope you won’t either.  You don’t need the grief.