Sleeping all the time

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Pumakitty
Pumakitty Member Posts: 652
in Head and Neck Cancer #1
I have a question for those of you who have used the pain patch. Did you sleep a lot? Dad is on his 7th patch and all he wants to do is sleep. The oncologist said it would make him sleepy, but I worry that he is sleeping to much. His tumor has already responed to the chemo and the doctor says it feels much smaller. But, it seems with each patch he stays out of bed less and less. Is this normal?


Kathy

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  • RogerRN43
    RogerRN43 Member Posts: 185
    #2
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    Hi Kathy
    When I nursed people on the Fentanyl patch, some slept a lot at the beginning because their pain was finally under control and their body needed it when prior, they lacked enough sleep, so it was like they were catching up. Other times, their heads had to get used to the initial sedative affects of the opiates and as they got use to the patch, they became more alert with more wake hours.

    I imagine it's not normal after the 3rd or 4th application (3 days each = 9-12 days), perhaps the dose is too strong. Consult your doctor about the proper step down in dosage, however, he may need more breakthrough oral pain meds (through the stomach tube) if pain is not controlled, that is the trade-off.
    Each patch lasts up to 96h, they are changed every 72h for overlap control. If he has normal kidney function, he should not have a problem clearing them out.

    Could responding to the treatment itself also add to the increased rest hours? Chemo can cause drops in CBC (complete blood count) levels which result in lower energy levels and easier to fatigue.

    The other thing I can think of is how is his mood? Wikipedia for the classical signs of depression which is cause by a chemical imbalance and can be corrected too.

    Does his oncologist have a primary nurse you could ask this? Mine is my go to person for any issues and she is great.

    Take care,
    Roger
  • Pumakitty
    Pumakitty Member Posts: 652
    #3
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    RogerRN43 said:

    Hi Kathy
    When I nursed people on the Fentanyl patch, some slept a lot at the beginning because their pain was finally under control and their body needed it when prior, they lacked enough sleep, so it was like they were catching up. Other times, their heads had to get used to the initial sedative affects of the opiates and as they got use to the patch, they became more alert with more wake hours.

    I imagine it's not normal after the 3rd or 4th application (3 days each = 9-12 days), perhaps the dose is too strong. Consult your doctor about the proper step down in dosage, however, he may need more breakthrough oral pain meds (through the stomach tube) if pain is not controlled, that is the trade-off.
    Each patch lasts up to 96h, they are changed every 72h for overlap control. If he has normal kidney function, he should not have a problem clearing them out.

    Could responding to the treatment itself also add to the increased rest hours? Chemo can cause drops in CBC (complete blood count) levels which result in lower energy levels and easier to fatigue.

    The other thing I can think of is how is his mood? Wikipedia for the classical signs of depression which is cause by a chemical imbalance and can be corrected too.

    Does his oncologist have a primary nurse you could ask this? Mine is my go to person for any issues and she is great.

    Take care,
    Roger

    Thanks Roger
    He is on the 25mg dose and does not have any break through pain. I plan to ask the nurse when he goes in for treatment Friday. I have been thinking that depression could also be an issue here. His blood counts have been perfect each week when they checked them prior to chemo.

    Thanks for your advice. I will let you know what I find out from the nurse.


    Kathy
  • Hondo
    Hondo Member Posts: 6,636 Member
    #4
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    Pumakitty said:

    Thanks Roger
    He is on the 25mg dose and does not have any break through pain. I plan to ask the nurse when he goes in for treatment Friday. I have been thinking that depression could also be an issue here. His blood counts have been perfect each week when they checked them prior to chemo.

    Thanks for your advice. I will let you know what I find out from the nurse.


    Kathy

    Hi Kathy

    I did not use the pain patch but was on some hard pain pills for about 8 months. And I did a little more sleeping then normal but that was because I was also very weak at the time. A rule of thumb is that too much of anything is not good. Agree that you should ask his doctor or nurse about it.

    Wishing the best for Dad
    ╠╣ONDO
  • sweetblood22
    sweetblood22 Member Posts: 3,228
    #5
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    I slept a lot.
    I was in bed for like two months straight at one point. When I was on 75 mcgs of fentanyl I was about comatose and still was in pain. It never made me feel high or anything, just exhausted. I did not drive while on that patch. Maybe a bit at the very end, when I was down to 25 and almost weaned off.
  • NJR
    NJR Member Posts: 82
    #6
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    Fentanyl
    I barely knew what sleep was for the first couple of months, even after 100 mcgh of fentanyl and 5mg morphine IV every hour but once the largest tumor had been shrunk significantly I was able to use the morphine oral solution strictly for breakthrough pains. The morphine almost always made me sleepy however the fentanyl never did. I just assumed that while I was at my low point, I became conditioned to it enough that it had no detectable affect on me at all. Never under estimate the Fentanyl patch though. Even though he is getting a very even dose that never wears off, one has to keep in mind that as far as strength goes, Fentanyl is about 100 times as powerful an opiate as pure morphine.

    If he isn't taking anything else that would cause him to sleep and he can handle the pain there would be nothing wrong with asking the Doc to knock him down 25 mcgh. I wouldn't recommend it though if that was the dose necessary to kill the pain without having something to supplement it, just in case.

    The most important thing about pain management that I found was to never let the pain get ahead of the pain killer. If he takes that patch off or Heaven forbid he runs out, it will take every bit of 18 hours for it to catch back up again. Say what you will about sleeping too much, but when it came to pain relief, all I can say is God Bless Fentanyl.
  • sweetblood22
    sweetblood22 Member Posts: 3,228
    #7
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    NJR said:

    Fentanyl
    I barely knew what sleep was for the first couple of months, even after 100 mcgh of fentanyl and 5mg morphine IV every hour but once the largest tumor had been shrunk significantly I was able to use the morphine oral solution strictly for breakthrough pains. The morphine almost always made me sleepy however the fentanyl never did. I just assumed that while I was at my low point, I became conditioned to it enough that it had no detectable affect on me at all. Never under estimate the Fentanyl patch though. Even though he is getting a very even dose that never wears off, one has to keep in mind that as far as strength goes, Fentanyl is about 100 times as powerful an opiate as pure morphine.

    If he isn't taking anything else that would cause him to sleep and he can handle the pain there would be nothing wrong with asking the Doc to knock him down 25 mcgh. I wouldn't recommend it though if that was the dose necessary to kill the pain without having something to supplement it, just in case.

    The most important thing about pain management that I found was to never let the pain get ahead of the pain killer. If he takes that patch off or Heaven forbid he runs out, it will take every bit of 18 hours for it to catch back up again. Say what you will about sleeping too much, but when it came to pain relief, all I can say is God Bless Fentanyl.

    NJR
    if your reply was for pumakitty, I think her father is only on 25mcgs.
  • Noellesmom
    Noellesmom Member Posts: 1,859 Member
    #8
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    sweetblood22 said:

    NJR
    if your reply was for pumakitty, I think her father is only on 25mcgs.

    Good heavens, YES!
    Kathy, Jim was first on the 25 and when his body got used to that, they had to bump it up to 50 mcg. He slept all the time, wherever and whenever and it was a blessed relief to see him sleep.

    It's used as an anesthetic for surgery: one would expect sleep and it does happen.

    If you are worried it is too much, be sure to check with his doctor and/or pharmacist.
  • tonyb
    tonyb Member Posts: 69
    #9
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    I am not sure if this will
    I am not sure if this will answer your question or not,
    but for me, during treatment and for a while after, the chemo and rads were just saping the strength out of me. All i could do for about 2 months was get up in the morning, go to treatment, go home and go back to bed. then i would stay in bed until it was time to go back for treatment. The pain and nausea made it hard to sleep. when the doctors got the pain meds and nausea stuff working, that made it possible to sleep. What i mean by this is the patch may not be making him sleep, but it may be making it possible to sleep, when he really needs to rest.
  • DrMary
    DrMary Member Posts: 531 Member
    #10
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    Opposite effect for my mother
    My mother's "Cruise Ship" memory care place had her up to very high doses of the patch, and she had trouble sleeping, with very odd nightmares about people speaking Chinese in her room all night. When I moved her down here to a small group home, they weaned her off the patches. She not only has little pain, but is more alert during the day and sleeps like a log at night. Of course, she was on those patches for years.

    I second the mention that treatment tires you out - I could see Doug's energy level drop about an hour after each radiation; he would take a 2-3 hour nap as soon as we got home (he was on oxycontin, as all of the other pain meds made him throw up - the patch was actually the worst for him, as he was barfing within hours of putting it on).

    I also agree with talking to his doctor - if for no other reason than to keep the doctor updated.
  • NJR
    NJR Member Posts: 82
    #11
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    sweetblood22 said:

    NJR
    if your reply was for pumakitty, I think her father is only on 25mcgs.

    Opps
    Oh my. I thought 25's were strictly for weaning off. I would never have even noticed that dosage had it not been for the fact that it was enough to kill any of the symptoms of withdrawal.

    Do they make a 12 or is 25 as low as they go?
  • sweetblood22
    sweetblood22 Member Posts: 3,228
    #12
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    NJR said:

    Opps
    Oh my. I thought 25's were strictly for weaning off. I would never have even noticed that dosage had it not been for the fact that it was enough to kill any of the symptoms of withdrawal.

    Do they make a 12 or is 25 as low as they go?

    NJR
    I believe that there is a 12mcg patch, because when I was weaning off, I stopped at 25mcgs, and I had very bad withdrawal. I thought that 25 *was* the last one, my doctor yelled at me. Miscommunication, he should have told me that I should wean down to 12mcg. Since I started at 25mcg, I thought that was the lowest. That withdrawal was not fun, I will tell you that.
  • jim and i
    jim and i Member Posts: 1,788 Member
    #13
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    Don't worry Kathy
    Jim slept the entire 2 months of treatment and he was only on 25mg of hydrocodone (which he very seldom used). The doctor said let him sleep his body needs it. He said radition was like running a marathon 24 hours a day; that all the energy my husband had was going to fighting the cancer so don't worry. Jim is about 12 weeks out from treastment and still sleeps more than usual but the doctor still says don't worry because they beat the heck out of him.

    How old is your dad? Age could have lot to do with it too.

    Praying for you and dad.

    Debbie
  • NJR
    NJR Member Posts: 82
    #14
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    sweetblood22 said:

    NJR
    I believe that there is a 12mcg patch, because when I was weaning off, I stopped at 25mcgs, and I had very bad withdrawal. I thought that 25 *was* the last one, my doctor yelled at me. Miscommunication, he should have told me that I should wean down to 12mcg. Since I started at 25mcg, I thought that was the lowest. That withdrawal was not fun, I will tell you that.

    Thanks Sweet
    That is good to know. I stopped at the 25's and never noticed it but I remain on the morphine so that covered it up I am sure. I got a taste of the withdrawals very early on when I failed to renew my prescriptions before a 4 day weekend and just after my first round of chemo. 100mcg Fentanyl and 2 tsp Morphine Sulfate Solution every two hours to nothing for two days. I got yelled at too. First by the Doctor and then by my daughter for the entire time it took to get two bags of saline in me and to stabilize my blood pressure.
    Needless to say, I became a much better patient and began to understand the gravity of my situation soon thereafter.

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