Sleep Apnea Is A Widespread Condition
Sleep apnea affects 30 million Americans. There is currently no cure for the condition, which can contribute to a host of debilitating and potentially lethal diseases including heart disease, stroke, and diabetes. (Learn more in 8 Things To Know About Sleep Apnea In The Workplace). The disease causes the upper airway to repeatedly close during the night, limiting oxygen intake and forcing sufferers awake. Warning signs for sleep apnea include snoring and daytime sleepiness.
It’s also an increasingly serious issue in the workplace, linked to decreased cognitive abilities and workplace accidents and injuries.
Existing Treatments Don't Work For Everyone
Treatment for sleep apnea often involves a Continuous Positive Airway Pressure (CPAP) machine or a dental device, both of which act to keep airways open while a patient sleeps. (Learn more in 5 Sleep Apnea Technologies Companies Are Testing On Workers). The CPAP is the most commonly prescribed and successful treatment for the physical symptoms of sleep apnea, but it is challenging to use, and many patients simply stop using it. There are currently no drugs to treat or cure sleep apnea. Positive results from a new study suggest that may be about to change, but the American Academy of Sleep Medicine says no.
A New Cure?
Researchers at Northwestern University and the University of Illinois at Chicago (UIC) studied the effects of varying amounts of dronabinol, a synthetic version of Delta-9 THC (tetrahydrocannabinol), otherwise known as cannabis. Dronabinol is already a Food and Drug Administration (FDA) approved drug used to combat nausea and vomiting.
The study was funded by National Institutes for Health and led by David W. Carley, a professor of biobehavioral health sciences at the University of Illinois at Chicago, and Dr. Phyllis Zee, professor of neurology at Northwestern University Feinberg School of Medicine and director of the Northwestern Medicine Sleep Disorders Center, both in Chicago, IL.
Unlike existing treatments which seek to combat the physical symptoms of sleep apnea, dronabinol targets the brain and the nerves that control the upper airways and alters the neurotransmitters that control these airways. The approach reflects a new way of approaching sleep apnea and an increasing understanding that the disease is caused by multiple factors including a brain that is no longer directing the airways in ways that is should.
When results from both animal testing and a small human pilot delivered promising results, researchers launched the latest study on a group of 73 patients who suffered from moderate or severe sleep apnea. Their results were published in the December 2017 edition of the journal Sleep. The participants were subdivided in three groups. One group received a low dose of dronabinol, another received a high dose and a third group took a placebo. The groups ingested the drug in pill form one hour before bed for a period of six weeks.
The group that took the highest dose — 10 mg of dronabinol daily — reported numerous positive results including less daytime sleepiness as well as fewer episodes of apnea and hypopnea. Apnea occurs when a patient stops breathing while hypopnea refers to overly shallow breathing. In comparison to full adoption of the CPAP machine, which in itself is very rare, sleep apnea symptoms were reduced by 33%.
These are impressive results and researchers point out that the effects last the entire night compared to the average of only four hours that most patients use their CPAP.
The Real Thing May Not Work
Ingesting real marijuana may not produce the same effects. The Northwestern study used a synthetic version of Delta-9-THC, just one of the many active ingredients in marijuana. Since real marijuana may include a variety of active ingredients, and the combination of those ingredients varies widely, it may not contain the active ingredient necessary for treating sleep apnea.
A New Ruling
In December 2017, the Minnesota State Department of Health added sleep apnea as a qualifying condition for its medical marijuana program. In the ruling, authorities cited modest research supporting the use of medical marijuana in relieving sleep apnea as well as the fact that so many people are unable to use CPAP machines effectively.
A New Warning
The Minnesota ruling might be a little premature for the American Academy of Sleep Medicine (AASM). The AASM released a policy statement in the April Issue of the Journal of Clinical Sleep Medicine that warned against the use of medical marijuana in the treatment of sleep apnea.
In its position paper, the AASM says that sleep apnea should be excluded from the list of qualifying conditions for state medical marijuana programs because delivery methods are unreliable and there is insufficient evidence of the drug’s effectiveness in the treatment of sleep apnea. The AASM also pointed out that there is little existing research on the drug with respect to long term tolerability or safety. And while the Northwestern study examined the use of synthetic marijuana in pill form there are no studies on other forms of ingestion including vaping or liquid formulations.
The AASM also cited concerns over daytime sleepiness, a common side effect of medical marijuana, and its potential impact on safety, including motor vehicle accidents.
More Research Needed
While their findings are promising, the authors of the Northwestern study would also like to see additional research on the use of dronabinol to combat sleep apnea. Because of the variability of active ingredients, they directly caution against smoking or inhaling marijuana as a treatment for sleep apnea. Further research would involve larger clinical trials and focus on the best ways to use cannabinoids like dronabinol in the treatment of sleep apnea. In the meantime, the Northwestern study does offer some hope of a more consistent and long-term treatment for sleep apnea sufferers.