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Inverting sleep schedule on warfarin

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slipkid

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I am on warfarin for my mechanical aortic valve. Have been for about 5 years. I test using a home meter about once a week (although that may be changing since Roche sold its business to Biotel Heart & I have had problems with them which make me believe I will have to drop them, but I digress).

I take warfarin daily at 8pm ever since my OHS. My (horrible) work schedule is such that I work 12 hour shifts that are 15 hour days, but I get home about 8pm (I get up about 5 to 5:30 AM). I usually go to sleep anywhere from 11pm to midnight (am exhausted all the time during my work periods since not enough sleep but just too much to do to be able to get to sleep any earlier).

Now I am finding out that I will have to go to nightshift starting in January (7pm-7am shift). Assuming the stress of trying to do that doesn't kill me outright or give me another heart attack (and it is near impossible to sleep here during the day but that is another issue) I am worried about what inverting my sleep schedule might do to my body's response to warfarin.

Am wondering if I should try inverting the warfarin as well and start taking it at 8AM instead of 8PM. I did ask my Dr about this but have not gotten a response yet. I am leaning towards taking the warfarin same time 8PM rather than risk monkeying around transitioning either taking it 12 hours earlier or later & what that will mean for the first day of this new shift from hell.

Just curious if anyone has any experience with this, or what people think, thanks.
 

pellicle

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Just change when you take it, it's not going to make any significant difference.

People over think this like it's mixing radioactive ingredients at tokaimura
 

slipkid

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Just change when you take it, it's not going to make any significant difference.

People over think this like it's mixing radioactive ingredients at tokaimura
If it makes no difference then I'd prefer to keep taking it at the same time as I do now (I'd rather avoid the transition period of skipping my dose entirely for one day, IE: taking it like 12 hours later etc, or taking it 12 hours earlier after taking it the previous night etc).

Unless sticking with the current time will affect something, since I will be taking it a few hours after getting up instead of in the evening a few hours b4 going to sleep....
 

pellicle

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Unless sticking with the current time will affect something,
a one off change to your time of taking a does will not make any clinicially significant difference and certainly not for long. You could move your taking time around every day if you wanted and that would probably only make a minor difference in INR on any given recording.
 

dick0236

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The most important thing is not to forget to take it. I find that the best way to avoid that problem is to take it at the same time every day.
I agree that it's best to develop a routine to take warfarin at about the same time each.....morning, noon or nite. A seven day pill box is a good reminder to take your pill.
 

slipkid

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Also, another reason for wanting to just keep taking it like I am is that (1) hoping to get back to day shift soon (or as remote as it may be to get the hell out of this godawful place and get a "real job" again), or (2) I will probably fail to make the adjustment to changing my sleep schedule and either have a car accident on the way home (last time I was on night shift it was only 1 week but I kept falling asleep in the car every time I stopped at a traffic light) or get fired because I am sure to have too many days late or get caught falling asleep at work, or will just have another heart attack making it all moot anyway (if I survive I will be able to make a case for retiring on disability or something, thus being back to a normal day/night pattern that way)....
 

LondonAndy

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I have not had to make much adjustment to the time of day I take my Warfarin, but if you would prefer to keep taking it at 8pm then I would be inclined to do that and see what, if any, difference the change of sleep pattern actually has. Presumably you don't need to report every result to your 'management service '? So don't.
 

tom in MO

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Also, another reason for wanting to just keep taking it like I am is that (1) hoping to get back to day shift soon (or as remote as it may be to get the hell out of this godawful place and get a "real job" again), or (2) I will probably fail to make the adjustment to changing my sleep schedule and either have a car accident on the way home (last time I was on night shift it was only 1 week but I kept falling asleep in the car every time I stopped at a traffic light) or get fired because I am sure to have too many days late or get caught falling asleep at work, or will just have another heart attack making it all moot anyway (if I survive I will be able to make a case for retiring on disability or something, thus being back to a normal day/night pattern that way)....
You might want to check to see if you have sleep apnea. That's a common cause of drowsiness and unintentional sleeping. If you sleep with someone ask them if you snore and stop breathing during snoring.
 

catwoman

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I agree with Tom in MO. I would talk to a primary care doctor about possible sleep apnea and undergo a study.
My husband had undiagnosed sleep apnea for years. He once fell asleep sitting upright while we had visitors in our home one day around noon. He complained about almost falling asleep at work or while driving. To compensate, he would go to bed earlier and earlier, yet it didn't help.
It wasn't until I shared a hotel room with a friend who snored like a freight train and, again, later after she was diagnosed with sleep apnea. She had had several car accidents due to drowsiness.
I alerted our PCP, who ordered a sleep study. My husband was DXed with obstructive sleep apnea (interior of his mouth is so small that it causes sleep apnea), and he got his first CPAP around 1998, I think. This resolved his frequent headaches and increased his energy.
He has had a number of CPAP machines over the last 22 years. They have become smaller, as have the masks.
 

tom in MO

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CPAP therapy can lower your blood pressure and in 25% of men there is an increase in sexual function.
 

slipkid

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You might want to check to see if you have sleep apnea. That's a common cause of drowsiness and unintentional sleeping. If you sleep with someone ask them if you snore and stop breathing during snoring.
Nothing to do with sleep apnea. I was talking about how hard it was when I had to work the nightshift one week a few years ago from 7pm to 7am and that causing me to fall asleep driving home. Try it sometime, especially on maybe 3-4 hours sleep a night (I mean day) if yer lucky o_O
 

Protimenow

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I used to snore a lot. The doctors set me up for tests to determine if I had sleep apnea, but I didn't want to test at home, and wasn't happy about going to a sleep lab.

After I came back from the hospital with most of my arrhythmias resolved, I slept on a slanted pillow -- it didn't help with the snoring.

I slept with no pillow, or with a standard size pillow that had lost most of its 'lift' - feathers had collapsed into each other or foam wore out - and this seemed to help, slightly.

Later, at my wife's suggestion (and reminder of an ENT's diagnosis of reflux acid burning my larynx), I started to take Prevacid at bedtime. This helped reduce the reflux when I slept.

I also noticed that a loud fan that we used during some hot summer days, also helped me to sleep - and reduced my snoring. Since then, I got an inexpensive sound generator - set it on a sound like an electric fan - and I rarely, if ever, snore.

I track my snoring - not as much lately - with an Android app called SnoreLab (or something similar) -- you set it up before bedtime, connect the charger, start the monitoring, then place the phone face down. It's a pretty good snoring tracker.
 
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