As a general rule, the American medical system seems to favor drug-based treatments whenever possible. As a result, about 70% of Americans take prescription drugs, and 20% of Americans were taking five or more prescription drugs. So it may seem miraculous that the two main sleep apnea treatments– CPAP and oral appliances — are non-drug treatments.
This isn’t for lack of trying. There have been many trials of drugs considered for the treatment of sleep apnea, but, as a Cochrane review published last year shows , there is little to no evidence that any of the drugs tried were effective in treating sleep apnea.
Drugs Tried for Sleep Apnea
Looking in its specialized database, the Cochrane Airways Group found thirty trials of 25 different drugs for sleep apnea. It should be noted that with a total study population of only 516, these are all likely very early stage trials, since drug trials tend to increase in population once they show success, and with a population of less than 20 per trial, it’s likely that these drugs were all dismal failures.
- Fluticasone (sold as Flonase)
- Donepezil (a dementia drug)
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
However, donepezil didn’t show any reduction in daytime sleepiness. Paroxetine also improved AHI but didn’t improve daytime symptoms. Another drug mirtazapine (Avanza and other names, an antidepressant) showed promise in an initial trial, but follow-up larger multicenter trials didn’t confirm the effects, and the drug came with significant weight gain and actual increases of daytime sleepiness. And none of the trials included long-term follow-up, so it’s impossible to say if the effects were short-term gains only.
Do We Want a Drug Treatment for Sleep Apnea?
With all the drugs that have been tried as treatments, it’s probably just as well that no drug has successfully been advanced for sleep apnea treatment. Drug treatments often come with serious side effects, and when you have two effective treatments with virtually no serious side effects, there is little reason to continue to pursue a sleep apnea drug.
Nonetheless, it’s likely that drug companies will continue their search. For them, the benefit is clear: revenue. With CPAP and oral appliances, you just buy them once and then you have them. Even if they break, get worn out, or are lost,replacements are few and far between, but with a daily medication, it’s possible to make significant profits.