What drugs can treat obstructive sleep apnea or daytime sleepiness?

Phil Westbrook
Sleep Medicine

A long list of drugs has been tried for the treatment of obstructive sleep apnea (OSA). Most of these have been medications that tend to stimulate breathing during wakefulness, such as progesterone, protripyline, nicotine, theophyline, naloxone, and acetazolamide. The hope was that these medications might increase the activity of the dilating muscles of the upper airway, activity that is normally decreased during sleep. Serotonin re-uptake blockers can increase activity in one of the dilating muscles, the tongue, but they have not been shown to significantly improve OSA. Unfortunately the search for a safe and effective "pill" to treat OSA has come up empty so far. There is no drug that can be recommended for treating the sleep induced collapse of the upper airway.

That is not the case for the symptom of daytime sleepiness. Excessive sleepiness is a primary consequence of OSA, one that does not always resolve completely with currently available treatments of the sleep-disordered breathing. The Food and Drug Administration has recently approved a drug – modafinil (Provigil®) – for the treatment of sleepiness that remains in spite of continuous positive airway pressure (CPAP) therapy for OSA. The mechanism of action of modafinil is not completely understood, but it clearly causes increased alertness, and is relatively free of unwanted side effects. Specifically it does not seem to have the unwanted effect on the heart and blood pressure that can occur with other stimulant medication. One concern is that patients might use the drug to make up for poor compliance with prescribed CPAP treatment of their OSA. Modafinil is NOT a treatment for sleep apnea; it is just a treatment for excessive sleepiness from any cause. It does not lessen the risk of serious cardiovascular consequences from inadequately treated OSA.

There are other central nervous system stimulants that can increase alertness. The most widely used is caffeine. Amphetamine-like drugs such as methylphenidate (Ritalin) are often prescribed for sleep disorders such as narcolepsy that cause severe excessive sleepiness.

Before you consider using a drug to treat your daytime sleepiness, be sure that you have treated your OSA as well as possible, and that you are getting enough sleep at night. Drugs are not a substitute for adequate sleep.

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