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 Post subject: Side Effects of Suboxone
PostPosted: Fri Nov 13, 2015 10:29 pm 
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Can Suboxone cause severe sleep apnea I have new diagnosis of severe central and obstructive sleep apnea. I am only 30 pounds over weight. I do not take any other sedating drugs. I have never used street drugs. I am not addicted but became physically dependent on them thru Dr prescriptions for chronic pain I am being given Suboxone for chronic pain not addiction. Sleep Dr thinks apnea due to Suboxone but Primary Care does not want me off it. I know I will go thru major withdrawal by going off of it. Already tried that Blood pressure went up to 180/110 Pulse up to 130. Not sure what to do.


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PostPosted: Fri Nov 13, 2015 11:16 pm 
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All opiates can cause respiratory depression which can, in turn, cause apnea. I'm not sure they're ruled by the same mechanism, but there is a relationship.

You don't have to be on much suboxone to ease chronic pain. How much are you on now? You might be on a dose that could be significantly decreased without having to give up the pain relieving benefits. Please tell me what dose you're on.

I am scared that I will end up with apnea because my mother had it. I could stand to lose some weight but I'm nowhere near as heavy as my mom was. But I take sub and she didn't.

Amy

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PostPosted: Sat Nov 14, 2015 12:26 am 
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As Amy wrote, opioids cause respiratory depression through their actions at mu receptors. The actual mechanism is a change in the response to carbon dioxide. In the absence of opioids, carbon dioxide levels above 40 mm mercury (a way to measure the amount of a gas in a mixture of other gasses) cause a sensation of shortness of breath, which makes the person increase 'ventilation' by the lungs by breathing faster and more-deeply. That 'blows off' carbon dioxide, lowering the level in the blood to normal levels. The body can get 'used to' chronic high levels of carbon dioxide in some cases-- in people with lung diseases like COPD, for example-- and those people will have higher levels of carbon dioxide without feeling shortness of breath.

Opioids shift the response to carbon dioxide. In extreme cases, the result is death by overdose. The rapid increase in opioids causes the body to ignore carbon dioxide, eliminating the drive to breathe. That causes the person to stop breathing for minutes, until the carbon dioxide level is high enough to stimulate breathing. During that absence of breathing-- called 'apnea'-- the level of oxygen drops, eventually to the point of causing either cardiac arrest or brain damage.

So ACUTE use of opioids can cause 'apnea'. But central sleep apnea is a different situation, where the brain does not respond as well to carbon dioxide with or without opioids. Understand that the effect of opioids at mu receptors is eliminated by tolerance-- and after tolerance develops, opioids like buprenorphine no longer change the response to carbon dioxide.

In other words, it is hard to imagine how buprenorphine can cause central sleep apnea, since all of the effects of buprenorphine on respiration are eliminated as tolerance develops. I can understand why a doctor would BLAME buprenorphine, since on a superficial basis opioids depress respiration. But a doc who understands the ceiling effect, the mechanism of respiratory depression, and the way that tolerance develops to buprenorphine would realize that the issue is much more complicated. The respiratory effects of buprenorphine are subject to the same ceiling as all of the other effects of the drug.


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PostPosted: Sat Nov 14, 2015 3:47 pm 
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Hi pyoung and welcome! I can tell you that thirty pounds made a big difference for my husband. He did a sleep study and was fitted for a machine. He was not happy about it at all! He started a healthy diet and got back into exercising on a regular basis. The sleep apnea went away. He sleeps through the night without snoring and waking himself up during the night. Now I sleep better too because there is no noise coming from his side of the bed! Have a good day!


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PostPosted: Sun Nov 15, 2015 5:13 am 
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30 pounds over is not alot but "a lot" in many ways if anyone is on suboxone it is very important to get in a routine to excursive even if it's alittle it will make a night and day deference .also it will help to let us know you dosage MG a day,how long when your on it,suboxone you need very little to help for pain as they all say about suboxone less is more.hope to hear more and hope you get this figured out wish the best!


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