It’s a growing problem – in many cases linked to the growing waistlines of Americans. Sleep apnea takes a toll on patients’ quality of life and work. And with limited treatments, doctors and sufferers long for an answer to a good night’s rest.
Dr Roneil Malkani, Northwestern Medicine neurologist and sleep medicine specialist: “When you’re awake, you have muscles in the upper airway that help hold it open. When you go to sleep, just like every other muscle in the body, it relaxes.”
If you’re overweight or have a naturally small airway …
Dr Malkani: “What happens is, your diaphragm tries to pull air in when you breathe, but it’s like breathing through a weak straw. When you suck in through a weak straw the walls go like that.”
With every breath in, the walls of the upper airway collapse.
Dr Malkani: “Your body is fighting to breathe, your blood oxygen goes down and your brain says, ‘Hey, gotta wake up.’ It causes a little bit of arousal, and then the muscles wake up and you start breathing again.”
It’s a repetitive cycle throughout the night, a constant interruption of sleep.
Dr Malkani: “If you don’t sleep well you don’t feel good. As you get chronically deprived of good quality sleep, you can develop problems with sleepiness during the day, dozing off unintentionally, particularly this is a problem when driving.”
The long term effects are even more life altering.
Dr Malkani: “The long term effects, it leads to higher risk of diabetes, high blood pressure, heart disease, strokes.”
There are few treatments. For some, losing a significant amount of weight can help — so does addressing underlying allergies and congestion.
Dr Malkani: “Then there’s the infamous CPAP.”
It’s not for everyone. Continuous positive airway pressure — or CPAP — machines deliver air through the nose or mouth – the pressure keeps airways open.
Dr Malkani: “They’re getting quieter and quieter. They are getting more comfortable.”
Still, there’s a need for more options. Not every patient can tolerate machines or mouth guards. What if simply popping a pill each night did the trick? It’s a question Northwestern Medicine neurologist Roneil Malkani is hoping to answer.
Dr Malkani: “This new medication, actually old medication, called dronabinol, is a medicine that affects certain neurotransmitters in the brain, serotonin and norepinephrine. And these neurotransmitters go down during sleep, and these seem to play a role in upper airway tone.”
Dr Malkani: “They go down during sleep, so the muscle relaxes a little bit more and leads to the obstruction.”
So the idea is to boost serotonin levels as patients sleep. Dronabinol – a cannabimimetic medication – meaning it’s a drug in the cannabis family – does just that. It’s been used to reduce weight loss in HIV patients and nausea and vomiting in those undergoing chemotherapy.
Dr. Malkani: “This brings up a possible problem in that patients with sleep apnea are a little obese, and on top of that, medication that was used to prevent weight loss doesn’t seem right. Data shows there is no significant weight gain from the doses we use for this study.”
Dr Malkani is hoping to enroll 60 patients in the sleep apnea pill study. UIC plans to enroll another 60.