Treating obstructive sleep apnea with medication

Obstructive sleep apnea (OSA) is currently treated with mechanical devices - air pressure from CPAP, jaw movement with oral appliance therapy, or surgical therapy. No medications have been shown to be particularly helpful in treating OSA. This article discusses NIH funding given to a team of researchers at the University of Chicago.

The article describes the research already going on at the University that focuses on a small group of cells in the carotid artery called the carotid bodies. When levels of oxygen in the blood drop, these carotid bodies send signals to the brainstem to increase breathing, with the goal of increasing oxygen levels in the blood. The article describes that in sleep apnea, the carotid bodies may not react appropriately, and thus stop sending signals to the brain. The University of Chicago team has developed a compound that may help the carotid bodies to keep working properly during sleep apnea, and thus aid in their regulation of breathing - at least in rodents.

However, it's not clear what type of sleep apnea the researchers are working on. It sounds like central sleep apnea (CSA), which is a completely different, and less common form of sleep apnea, than OSA. In most cases of OSA, the drive to breathe is intact, but airflow is significantly reduced due to a blockage in the upper airway. In addition, not every patient with OSA has oxygen level reductions, even though airflow through the upper airway is reduced. But if a person with OSA has regular blood oxygen level reductions, perhaps a medication that helps the carotid bodies stimulate breathing may be effective, if that stimulation involves increasing the diameter of the upper airway.

Herbal remedies and insomnia

There is a review of the efficacy of herbal remedies in treating insomnia. The aim of the study was to review the published literature on treating insomnia with herbal remedies.

Valerian root was shown to probably be safe, but the studies regarding efficacy were inconclusive. Kava-kava was shown in one study to be effective, but safety concerns including skin reactions, neurological complications, and liver damage have prompted the FDA to issue an advisory statement about its use. Chamomile and St. John's wort have very few articles supporting their use in treating insomnia. Lemon balm, passionflower, and lavender have no published articles on their efficacy in insomnia.

While the temptation to try these herbal remedies is understandable, just because a compound seems "natural" does not mean it is safe and/or effective in managing insomnia. Cognitive behavioral therapy (CBT) has been shown to be safe and effective for insomnia, and does not involve ingesting any substances. With CBT, you learn skills that will help you sleep for the rest of your life.

Insomnia and Brain Cooling

A research study was presented at the annual Sleep meeting in Minneapolis about treating insomnia by cooling the brain - called frontal cerebral thermal transfer. The study included 24 patients, half with insomnia and half without. The study subjects wore soft, plastic caps with circulating water that could be cooled to different temperatures. The results showed that in those with insomnia that were treated with the maximal cooling temperature fell asleep in 13 minutes and slept 89% of the time they were in bed. This is compared to the subjects without insomnia who fell asleep in 16 minutes and slept for 89% of the time they were in bed.

The researchers do not know why the cooling helps but they do have a theory. People with insomnia have increased metabolism in the front part of their brain. And cooling that part of the brain may reduce metabolism enough to improve sleep quality. This cooling cap could be an alternative to sleeping pills.