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Adventures in Sleep

Sleep Aids in CPAP Titration: What are ENTs taught?

Published February 9, 2012 4:25 PM by Penny Mehaffey
Penny Mehaffey, RPSGTFrustrated.  Yep, that would be the best way to describe me right now. And why am I frustrated you may ask? 

Well, I recently had a patient who told me that he has insomnia and cannot go to sleep before 4 a.m. no matter how early he goes to bed. Said patient needs a CPAP titration and, anticipating the problems associated with his complaints, I asked his doctor about a sleep aid for the night of the study. Here's what frustrated me: the doctor said no.

He proceeded to tell me that sleep aids are contraindicated in obstructive sleep apnea and that he could not order a med for this patient. What? Did he just say that? What's wrong with him? I will tell you what's wrong: He is an ENT doc, not a sleep doc. 

I read a study in ENTtoday with three control groups that found that...wait for it...there is not significant evidence to support that use of a sleep aid to help users acclimate to CPAP nor does a sleep aid increase the long-term use of CPAP.  I wonder how many of that group fit the description of this patient, moderate to severe OSA with insomnia and possible delayed sleep phase?  The article did give a nod to the use of sleep aids in specific circumstances that were not really specified.

While I respect a doctor's right to treat his patients his way,  I am really aggravated to think this patient will most likely come for the titration study, not sleep, leave with an unacceptable titration, and probably have to repeat it.  I personally have seen the benefit of using a sleep med to help CPAP users adjust.  I am so accustomed to sleep medicine's way of doing things (which I believe is the right way) that I just can't believe someone would choose the probability of failure. 

I should have asked the sleep doc.

Anyone have any advice to offer?

posted by Penny Mehaffey


I am unfamiliar with SOMNO BLISS but I do have experience with Melatonin and a product called BIO Zzzz.  From time to time, I have used both at home with good results.  I was just taken aback with the verocity the ENT semed to have toward a sleep aid and how different the views are between sleep & ent..of course anyone with untreated sleep apnea should not take these types of meds..I have an ENT speakking to my A.W.A.K.E support group next month.  I plan to open the discussion with him.

PENNY March 17, 2012 5:04 AM

You can always recommend the patient use a non prescription sleep aid, such as SomnoBliss, which is an herbal blend of proven sleep inducing ingredients.  We have found that for patients who have a problem acclimating to the wearing of a CPAP mask, were able to better tolerate the transition by using SomnoBliss.

Craig Meyer February 21, 2012 7:08 AM

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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