Sleep ap­nea cure still a mys­tery

Reme­dies com­pete for con­sumers, but are earn­ing medi­ocre re­views

Windsor Star - - YOU - CARLA K. JOHN­SON

It’s been two decades since doc­tors fully rec­og­nized breath­ing that stops and starts dur­ing sleep is tied to a host of health is­sues, but there still isn’t a treat­ment that most peo­ple find easy to use. Air­way pres­sure masks, the most com­mon rem­edy, have im­proved in de­sign, get­ting smaller and qui­eter, but pa­tients still com­plain about sore nos­trils, dry mouths and claus­tro­pho­bia.

Now, new ways of con­quer­ing sleep ap­nea, and the ex­plo­sive snor­ing that comes with it, are vy­ing for a place in the bed­rooms of mil­lions of peo­ple crav­ing a good night’s sleep.

Prod­ucts range from a $350 re­straint meant to dis­cour­age back sleeping to a $24,000 sur­gi­cal im­plant that pushes the tongue for­ward with each breath. Mouth­pieces, fit­ted by den­tists, work for some peo­ple but have their own prob­lems, in­clud­ing jaw pain. Some pa­tients try surgery, but it of­ten doesn’t work. Doc­tors rec­om­mend weight loss, but diet and ex­er­cise can be chal­leng­ing for peo­ple who aren’t sleeping well. So far, no pills for sleep ap­nea ex­ist. One drug con­tain­ing THC, the ac­tive in­gre­di­ent in mar­i­juana, showed prom­ise in a study this year.

In peo­ple with the con­di­tion, throat and tongue mus­cles re­lax and block the air­way dur­ing sleep, caused by obe­sity, ag­ing or fa­cial struc­ture. They stop breath­ing, some­times for up to a minute and hun­dreds of times each night, then awake with loud gasp­ing and snor­ing. That pre­vents them from get­ting deep, restora­tive sleep. They are more likely than oth­ers to have strokes, heart at­tacks and heart rhythm prob­lems, and they’re more likely to die pre­ma­turely. But it’s hard to tease out whether those prob­lems are caused by sleep ap­nea it­self, or by ex­cess weight, lack of ex­er­cise or some­thing else en­tirely. For spe­cial­ists, the first-choice, most-stud­ied rem­edy re­mains con­tin­u­ous pos­i­tive air­way pres­sure, or CPAP. It’s a mo­tor­ized de­vice that pumps air through a mask to open a sleeper’s air­way. About five mil­lion Amer­i­cans have tried CPAP, but up to a third gave up dur­ing the first sev­eral years be­cause of dis­com­fort and inconvenience. Martin Braun, 76, of New York City stopped us­ing his noisy ma­chine and awk­ward mask, but now he’s try­ing again af­ter a car crash when he fell asleep at the wheel. “That’s when I re­al­ized, OK this is se­ri­ous stuff al­ready,” said Braun, who has or­dered a qui­eter CPAP model.

While sci­en­tists haven’t proved CPAP helps peo­ple live longer, ev­i­dence shows it can re­duce blood pres­sure, im­prove day­time sleepi­ness, lessen snor­ing and re­duce the num­ber of times a pa­tient stops breath­ing. CPAP also im­proves qual­ity of life, mood and pro­duc­tiv­ity.

“It’s the bane of my ex­is­tence as a sleep doctor,” said Dr. James Row­ley of Wayne State Univer­sity in Detroit.

“A lot of what sleep doc­tors do in the first few months af­ter di­ag­no­sis is help peo­ple be able to use their CPAP.”

All told, it can drive peo­ple to­ward surgery.

The THC pill, known as dron­abi­nol, al­ready is used to ease chemo­ther­apy side ef­fects. A small ex­per­i­ment in 73 peo­ple sug­gests it helps some but wasn’t com­pletely ef­fec­tive. It may work bet­ter in com­bi­na­tion with CPAP or other de­vices, said re­searcher David Car­ley of the Univer­sity of Illi­nois at Chicago. He owns stock in Re­spire Rx Phar­ma­ceu­ti­cals, which has a li­cens­ing agree­ment with the univer­sity for a sleep ap­nea pill.

As the search for bet­ter treat­ments con­tin­ues, lis­ten­ing to pa­tients is key, said Red­line. “We are ac­tu­ally just treat­ing a very tiny per­cent­age of peo­ple ef­fec­tively,” she said.

THE AS­SO­CI­ATED PRESS

A tech­ni­cian pre­pares equip­ment to mon­i­tor Martin Braun’s brain ac­tiv­ity dur­ing a sleep study in New York. Braun de­cided to take his sleep ap­nea more se­ri­ously af­ter he fell asleep at the wheel.

David Car­ley

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