Sleep apnea cure still a mystery
Remedies compete for consumers, but are earning mediocre reviews
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.
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.