Sleep Aids in CPAP Titration: What are ENTs taught?
Frustrated. 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?