The American medical system generally loves its drugs. As a result, about 70% of Americans take at least one prescription drug, and 20% of us take five or more. Crunch the numbers on that and you can see that there’s a lot of revenue there, revenue that pharmaceutical companies are more than happy to collect.
So it is perhaps remarkably that there’s no drug treatment for sleep apnea, although there are several effective nonsurgical treatment options, including CPAP and oral appliances. But this isn’t because companies aren’t trying. A Cochrane review published last year identified 30 trials of 25 different drugs for sleep apnea, and little evidence that any of them were any good.
Drugs Tried for Sleep Apnea
So, with 25 different drugs being tried, surely some of them had to have promise. Actually, not really. The total study population of these 30 trials was only 516, or an average of about 17 people per study. These very small trials show they are tentative experiments, casting around almost at random to try to find a positive effect, so it’s not too big a surprise that they actually didn’t end in anything other than a dismal failure.
Reviewing the studies, it was found that of the 25 drugs, only 10 resulted in any reduction in the apnea/hypopnea index of patients. Even fewer were capable of doing significantly better than placebo, so we’ve listed them here:
- Fluticasone (sold as Flonase)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Donepezil (a dementia drug)
But even when drugs resulted in AHI improvement, they still were bad failures. Donepezil and paroxetine reduced AHI, but not daytime sleepiness. A fifth drug, mirtazapine (an anitdepressant sold as Avanza and other brands) showed some promise at first, but in a follow-up multicenter trial there was no significant AHI reduction, weight gain, and an actual increase in daytime sleepiness.
And with these trials all conducted over very short periods, we don’t know if the miniscule gains are temporary or longer-term.
Do We Want a Drug Treatment for Sleep Apnea?
When it comes down to it, we are all probably happier that no drug has proven effective as a sleep apnea treatment. Drugs often come with serious side effects, compared to the relatively minor side effects that come with oral appliances or CPAP.
And then there’s the revenue question. A CPAP device or oral appliance is a durable piece of equipment, and, though it may break or wear down, it doesn’t need to be bought again daily. Which is what pharmaceutical companies are hoping for, another twelve million or more customers, paying for their prescriptions and bumping the fraction of us taking a drug just a little closer to 100%.
Want to learn more about effective, drug-free treatment of sleep apnea? Please call 303-691-0267 for an appointment at the TMJ Therapy & Sleep Center of Colorado in Denver.