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[News] Take a pill instead of CPAP?
Sleeping Angels
How children's sleep affects their health and well being.
by Dennis Rosen, M.D.

Medicine Instead Of CPAP For Obstructive Sleep Apnea?

Study offers hope for new treatment of common nighttime breathing disorder

Does the prospect of having to wear CPAP each night, every night, for the foreseeable future keep you from sleeping? A new study holds out the promise of one day being able to treat obstructive sleep apnea with a pill, instead of CPAP.

Obstructive sleep apnea, a condition in which the muscles of the throat relax to the point that the throat actually collapses, blocking airflow to the lungs, and resulting in dozens, even hundreds of awakenings at night, is a condition from which millions of Americans suffer.

As anyone who has ever carried a sleeping child to his bed well knows, muscle relaxation is part of sleep. What is less commonly appreciated, however, is that this relaxation is especially prominent in a stage of sleep known as REM (rapid eye movement) sleep. In REM, we lose muscle tone in almost all of our muscles, except for our eye muscles (hence its name) and our diaphragm, the largest muscle involved in breathing. On the one hand, this is a good thing: if not, we’d be running into walls and tripping over night tables as we acted out our dreams. On the other hand, this loss of muscle tone extends to the muscles of our throat, making them more prone to collapse, and making us especially prone to OSA during this sleep state, which comprises 25 percent of sleep.

Researchers at the University of Toronto reported this week that they have identified the main mechanism responsible for the relaxation of the throat muscles in REM sleep, as well as a way to medically reverse it (in rats, not in humans, though it is likely to be very similar in both species). This is great news, as millions of people struggle nightly with CPAP, a machine that blows air into their throat, so that they can breathe (and sleep) comfortably at night.

Many people with obstructive sleep apnea dislike, and therefore don’t use, CPAP. Those who forgo treating their obstructive sleep apnea have to deal not only with being chronically sleepy, but also with increased risk of heart disease, diabetes, and high blood pressure. This discovery is terrifically important, as it holds out the promise that it may be possible, within a few years, to treat obstructive sleep apnea with a pill instead of CPAP.

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Yeah, don't hold your breath about this - even after rat trials, it still will have to work in humans and prove non-toxic over a long period of time. If you have a choice between taking a pill every night for the rest of your life and possibly building up a damaged liver and using a CPAP with no side effects then which would you choose? Either way, if this pill got approved for human trials tomorrow, you are still talking about ten years before it will be cleared as safe.
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Now if there was a fix for the centrals too i would wait Ten years

right now my Mask is driving me nuts USA replacement every 3 mths here in Canada a new mask Once a Year

We Breath differently here in Canada it would seem oh well only 7 mth left before i can get a new one or pay out of pocket
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I am on quite a few drugs right now as it is. I wonder what side effects the rats were having?
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

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I'd be very happy if they bring out a pill that works for apnea as long as the side effects were minimal
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By the time that pill comes out I'll be so used to sleeping with a CPAP machine that I won't know how to sleep without it!
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My concern is not the immediate side effects but the long term effects on the liver and pancreas. A lot of drugs that people have to take long term can cause eventual toxic effects on the liver, and the judgement is usually that even it wrecks your liver eventually, it still extends your life or quality of life longer than if you weren't on the drugs, so we prescribe them anyway. But it is a calculated risk that in some cases we are only now beginning to see the outcome of, given that many of the long term pills that are now commonly prescribed are only 30 or 40 years old, and we are only now getting to see the toxic effects of long term use. The real exception to that is Aspirin in low dose form - here we have masses of data accumulated, and it all shows a strong positive effect, but new drugs take years to show up problems like those I mentioned.

Hence my feeling that if you had a choice between a pill and possible liver cancer 30 years or less down the road, or a CPAP and no cancer, then I'd take the CPAP, despite my being passed middle age (unless you know people who make it to 115 years of age).

Incidentally, we don't really know exactly how much negative effect long term use of CPAPs may have, given the amount of air forced into the system. No one has done mortality studies on that yet. However, the long term positive effects are known, in comparison to not using the therapy and still having a middle to high AHI.
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Is there something in particular about this drug vs. the liver and pancreas, or are you just talking about the general effect of daily drugs?

I always say that long term CPAP causes aging.

In the same sense that drunk driving prevents aging.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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I am concerned about long term effects of any drug - there is ample evidence that the bulk of the drugs we have to take daily for lots of conditions eventually damage the liver, pancreas or kidneys, either through slow erosion or toxic build-up. The calculation is that it is either the pill and a later death due to organ failure of one sort or another, or don't take the pill and have an early death because to the effects of the disease or condition that would necessitate the pill in the first place. It is usually in the literature of most of the drugs, but we tend not to talk about it to patients very much, because it is a risk calculation that is necessary (and there is no 100% chance that you would develop toxicity from the pill, just a high enough chance as to make it worth thinking about). The exception's when we are talking to younger people about some long term pill or other - there we do outline the risk, because they likely have a long enough life to encounter the toxic effects at a younger age than, say, someone at 50 first going on some of those pills, given that it may take 30 to 40 years for the toxic effects to show. And we figure that 80 is a good run in most cases.

So here we have something that may not show for 30 years and may kill you (or not, the lab work for that won't be in for 30 years) or we have something that has no noticeable side effects (although the air swallowing may cause erosion of the stomach or intestines or may encourage diverticulitis, and of course, there is a slight cancer risk with the increase of air intake, but nothing like it would be one O2 alone) and is safe for extreme long term use. Which do you choose? Which should a physician recommend?
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(02-21-2013, 05:59 PM)britincanada Wrote: Now if there was a fix for the centrals too i would wait Ten years

right now my Mask is driving me nuts USA replacement every 3 mths here in Canada a new mask Once a Year

We Breath differently here in Canada it would seem oh well only 7 mth left before i can get a new one or pay out of pocket

Yes & we Canadians were always told that we have a better medical system than the US but I must be missing something because my medical told me that they only pay for 1 mask total after that too bad so sad.
My mask is leaking all the time now & last night I had over 61 mins in total leak.
The problem with medical plans like any insurance is the want to pay the very least but cant see the bigger picture by not doing the proper thing in the beginning will eventually end up costing the medical system way more in the end when a CPAP users leaking mask may be the cause of a bad car accident involving multiple expensive medical costs not to mention death & destroyed families that could have been saved by a mask that costs less than $200.00.

I could Rant about this all night but I need to get more sleep.

I think medical insurance & any other type of insurance companies are not much different then Casinos, they would be there if they weren't able to make millions from us & make it hard as hell to get benefit payments.

At least Casinos offer entertainment & higher oxygen levels I could use some of that Oxygen that is.
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