The Complication of Medication in Sleep Apnea


What happens when you suddenly stop breathing during sleep? In sleep apnea, airflow to the lungs is either partially or completely disrupted, causing breathing to stop and recontinue repeatedly during sleep (National, Heart, Blood, and Lung Institute, n.d.). Sleep apnea is one of the most common sleep disorders, estimated to affect over 900 million people worldwide (RT Magazine, n.d.). It can be divided into three categories: obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea (combination of both OSA and CSA). In obstructive sleep apnea, the upper airways are blocked due to physiological aspects (throat muscles relax and block upper airways), while in central sleep apnea brain signals to the muscles that control breathing are disrupted. Though the categories have distinctive differences in their characteristics, all three pose serious health risks to those affected, including cardiovascular illnesses (which may lead to premature death) (American Academy of Sleep Science, 2008) as well as excessive daytime sleepiness.

 A notable but typically overlooked influencing factor in sleep apnea is the effect of prescribed medication. A major group of medications that may cause or worsen sleep apnea are opioids. Typically used as painkillers, the highly addictive drugs include oxycodone, morphine, and codeine. The use of opioids may lead to muscle relaxation, which causes breathing patterns to become irregular and potentially stop for a period of time, as well as respiratory suppression. The chronic use of opioids has been linked to the development of central sleep apnea, and unrecognized this condition may lead to opioid overdose and death (Correa et al., 2015). In one study, it was found that 75-85% of the subjects treated with opioids had “at least mild sleep apnea that is severe in 36 to 41% of cases depending on the dose” (Duffy, 2019). Similar effects can be seen in other medications, including prescription over-the-counter tranquilizers like sleeping pills. Like in opioids, when taking sleep medication, such as Benadryl and Ambien, increased muscle relaxation occurs, which could cause blockage of the airways to occur (Winkler, 2015). 

Medication used to treat other mental disorders also influence the development and aggravation of sleep apnea. Chronic use of benzodiazepines, typically used to treat anxiety disorders and muscle spasms (like Xanax and Valium), have been found to cause “complete obstructive sleep apnea in heavy snorers or short repetitive central sleep apnea in patients with recent myocardial infarction” (Guilleminault, 1990). Like in opioids and tranquilizers, these medications also have a muscle relaxation effect on the body that can lead to obstructive sleep apnea. Antidepressants also affect sleep apnea. However, unlike the aforementioned substances, instead of increased muscle relaxation, antidepressants may cause sleep apnea through antidepressant induced weight gain (Wichniak et al., 2017). The increased weight in the neck area may narrow airways and block the flow of air to the lungs, increasing the frequency of night wakings. 

It should be noted many people with sleep apnea disorder are undiagnosed, further increasing the risk of other illness developments and accidents. Many people with sleep apnea may not be aware of its presence due to a range of reasons, including misdiagnosis from health professionals as another disorder (such as depression or ADHD) and ignored normalized symptoms like loud snoring. Potential symptoms that may have gone unnoticed may also be exacerbated by prescribed medication or other substances. By increasing awareness in society and education on sleep apnea, as well as the potential substances that may cause or increase its severity, we can increase the recognition of sleep apnea. Thousands of lives could potentially be saved, and countless others may gain effective treatment and tailored medical advising for reducing debilitating symptoms.

 

References

Correa, D., Farney, R. J., Chung, F., Prasad, A., Lam, D., & Wong, J. (2015). Chronic opioid use and central sleep apnea: a review of the prevalence, mechanisms, and perioperative considerations. Anesthesia and analgesia, 120(6), 1273–1285. https://doi.org/10.1213/ANE.0000000000000672 

Duffy, S. (2016, October 19). Which drugs have positive, negative impact on sleep apnea? MPR. https://www.empr.com/home/news/which-drugs-have-positive-negative-impacts-on-sleep-apnea/ 

Guilleminault C. (1990). Benzodiazepines, breathing, and sleep. The American journal of medicine, 88(3A), 25S–28S. https://doi.org/10.1016/0002-9343(90)90282- 

One Billion People Worldwide Have Sleep Apnea. (2018, May 21) . RT Magazine.  https://rtmagazine.com/disorders-diseases/sleep-medicine/one-billion-people-worldwide- sleep-apnea/ 

Sleep Apnea (n.d.). National, Heart, Blood, and Lung Institute. Retrieved October 22th, 

2020, from https://www.nhlbi.nih.gov/health-topics/sleep-apnea 

Study shows that people with sleep apnea have a high risk of death. (2008, August 1). American Academy of Sleep Science. https://aasm.org/study-shows-that-people-with-sleep-apnea-have-a-high-risk-of-death/ 

Wichniak, A., Wierzbicka, A., Walęcka, M., & Jernajczyk, W. (2017). Effects of Antidepressants on Sleep. Current psychiatry reports, 19(9), 63. https://doi.org/10.1007/s11920-017-0816-4 

Winkler, T. (2015, March 27). How sleeping pills make your sleep apnea worse—and what to do about it. My Sleep Apnea MD https://www.empr.com/home/news/which-drugs-have-positive-negative-impacts-on-sleep-apnea/

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